目的：比较不同围手术时期给予玻璃体腔内注射康柏西普联合25G微创玻璃体手术(PPV)及小梁切除术治疗继发于增生型糖尿病视网膜病变(PDR)伴玻璃体积血(VH)的新生血管性青光眼(NVG)的手术效果及并发症。

方法：前瞻性随机对照临床试验。纳入2016-11/2019-04在我院确诊的PDR伴VH的Ⅲ期NVG患者28例30眼。所有患者均接受25G PPV联合小梁切除术。将其随机分为两组：第1组12例14眼患者于术前3d玻璃体腔内注射康柏西普，第2组16例16眼于25G玻璃体手术及小梁切除术毕玻璃体腔内注射康柏西普(IVC)0.5mg/0.05mL。比较两组患者手术时间、术中出血及术后并发症的发生率。观察术后疼痛缓解、虹膜新生血管(INV)消退和最佳矫正视力(BCVA)以及眼压(IOP)控制率情况。

结果：第1、2组均完成手术并分别随访12.40±2.21mo和12.23±2.11mo(P>0.05)。第1组术中出血和术后早期前房出血发生率(29%、14%)低于第2组(75%、56%，均P<0.05)。两组患者手术时间、浅前房、脉络膜脱离、玻璃体再出血的发生率无差异(P>0.05)。术后3d所有患者疼痛缓解。第1组IVC后3d(即手术日)93%的INV完全消退，第2组PPV术后7d 94% INV完全消退。末次随访两组患者各有1眼残余少许萎缩的INV。术后1wk，1、3、6mo IOP控制率，第1组依次为93%、79%、64%、57%，第2组依次为94%、75%、50%、44%，两组患者各时间段比较无差异(P>0.05)。两组术后不同时间点IOP与术前相比均明显降低(P<0.05)。末次随访时第1、2组IOP分别为20.45±10.55和22.63±7.24mmHg，与术前42.21±9.11和44.88±11.83mmHg相比明显降低(P<0.05)。两组术后不同随访时间点BCVA与术前相比无差异(P>0.05)。

结论：术前IVC预处理与术毕IVC联合25G PPV及小梁切除术治疗继发于PDR伴VH的NVG相比，术中出血和术后早期前房出血的发生率较低。两种方法IOP控制率相当，虽然随着时间逐渐减低，但是经过及时处理最终可以获得较好的疗效。

METHODS: Prospective randomized controlled clinical trial. 28 cases(30 eyes)of NVG in stage Ⅲ secondary to PDR with VH were enrolled in the study. All patients received 25G PPV combined with trabeculectomy. They were randomly divided into two groups: group 1(14 eyes)received intravitreal injection of 0.5mg/0.05mL of conbercept(IVC)3d before operation and group 2(16 eyes)received IVC after operation; the operation time, intraoperative bleeding and postoperative complications were compared between the two groups. The differences of pain relief, the regression of iris neovascularization(INV), the best corrected visual acuity(BCVA)and intraocular pressure(IOP)control rate were observed.

RESULTS: The two groups all completed the operation and were followed up 12.40±2.21mo and 12.23±2.11mo respectively(P>0.05). The incidence of intraoperative and early postoperative hyphema of group 1(29%, 14%)was lower than group 2(75%, 56%, P<0.05). There was no significant difference in operation time, shallow anterior chamber, choroidal detachment and vitreous rebleeding between the two groups(P>0.05). The pain was relieved in all patients 3d after operation. In group 1, 93% of INV completely disappeared 3d after IVC and 94% of INV completely disappeared 7d after PPV in group 2. At the last follow-up, one eye in each group remained a little atrophic INV. At 1wk, 1mo, 3mo, 6mo postoperation, the IOP control rate of group 1 was 93%, 79%, 64% and 57% respectively, and that of group 2 was 94%, 75%, 50%, 44% respectively(each time period, P>0.05). IOP of the two groups at different time points after operation was significantly lower than that before operation(P<0.05). At the last follow-up, the IOP of the two groups were 20.45±10.55 and 22.63±7.24mmHg respectively, which were significantly lower than those of 42.21± 9.11 and 44.88±11.83mmHg before operation(P<0.05). BCVA in two groups at different follow-up time after operation has no significant difference compared with that of preoperation(P>0.05).

CONCLUSION: Compared with IVC after operation, IVC before operation combined with 25G PPV and trabeculectomy for NVG secondary to PDR with VH could reduce the incidence of intraoperative hemorrhage and early postoperative hyphema. The IOP control rate of the two methods is equal and gradually decreases with time, but after timely treatment can finally get better results.