不同联合手术治疗伴有和不伴有玻璃体积血的新生血管性青光眼

目的：探讨玻璃体腔注射康柏西普联合青光眼引流器植入及视网膜激光光凝对伴有和不伴有玻璃体积血的新生血管性青光眼(NVG)的疗效。

方法：回顾性分析了2016/01～2017/12在西安市第一医院眼科被确诊的37例39眼伴有和不伴有玻璃体积血的NVG(虹膜房角黏连超过180°)患者的临床资料。根据是否有玻璃体积血分为两组。所有患者均接受0.5mg(0.05mL)玻璃体腔注射康柏西普。没有玻璃体积血的20例21眼(第1组)患者在玻璃体腔注射康柏西普后4d行EX-PRESS(P50)青光眼引流器植入，在青光眼引流器植入后2wk行全视网膜激光光凝。伴有玻璃体积血的17例18眼(第2组)患者在玻璃体腔注射康柏西普后4d行玻璃体切除联合EX-PRESS(P50)青光眼引流器植入及全视网膜激光光凝术，并且根据术中的实际情况选择填充空气或硅油。所有患者术后随访6mo。

结果：第1组患者术前与术后6mo最佳矫正视力(BCVA)无差异(P>0.05)； 第2组患者术前与术后6mo BCVA有差异(P<0.05)； 第1组患者术后1d，1wk、1、3和6mo眼压分别为20.5±4.3mmHg，19.6±3.8mmHg，20.1±3.7mmHg，19.9±4.2mmHg和19.3±2.9mmHg。第2组患者术后1d，1wk、1、3和6mo眼压分别为22.3±3.7mmHg，20.6±2.8mmHg，20.4±3.8mmHg，18.9±4.1mmHg和19.3±3.4mmHg。第1组和第2组患者术后平均眼压均低于术前眼压(P<0.05)，在随访期间3眼出现虹膜新生血管复发，故再行1次玻璃体腔注射康柏西普，治疗1wk后虹膜新生血管消退。

结论：玻璃体腔注射康柏西普联合青光眼引流器植入及视网膜激光光凝能够有效降低伴有和不伴有玻璃体积血的NVG(虹膜房角黏连超过180°)患者的眼内压。

Different surgical combinations for neovascular glaucoma with and without vitreous hemorrhage

AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.

METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi''an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.

RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(P>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(P<0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(P<0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection.

CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).