玻璃体腔注射雷珠单抗联合FP-7Ahmed青光眼引流阀植入术治疗新生血管性青光眼的疗效观察
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摘要
目的探讨玻璃体腔注射雷珠单抗联合FP-7Ahmed青光眼引流阀植入术治疗新生血管性青光眼(NVG)的疗效。方法选取采用玻璃体腔注射雷珠单抗联合FP-7Ahmed青光眼引流阀植入术治疗的NVG患者36例(38眼)作为观察组,选取同期仅给予FP-7Ahmed青光眼引流阀植入术治疗的NVG患者34例(35眼)作为对照组。比较两组患者虹膜表面新生血管消退情况、眼压、视力及并发症发生率。结果观察组35眼(92.1%)虹膜表面新生血管完全消退,3眼(7.9%)残存少许新生血管,对照组所有患者虹膜表面仍可见新生血管。观察组术后1d、7d、1个月、3个月和6个月眼压均显著低于对照组(均P<0.05)。观察组术后6个月视力较对照组显著改善(P<0.05)。两组患者角膜水肿、前房渗出、浅前房和低眼压发生率比较差异均无统计学意义(均P>0.05)。观察组前房出血和引流管堵塞发生率均显著低于对照组(均P<0.05)。结论玻璃体腔注射雷珠单抗联合FP-7Ahmed青光眼引流阀植入术治疗NVG安全有效。
Objective To evaluate the efficacy of ranibizumab combined with FP-7 Ahmed valve implantation for neovascular glaucoma(NVG). Methods Seventy patients(73 eyes) with NVG were assigned in two groups: 34 cases(35 eyes)were treated with FP-7 Ahmed valve implantation(control group) and 36 cases(38 eyes) were treated with FP-7 Ahmed valve implantation and ranibizumab(study group). The neovascular vanishment, intraocular pressure, vision and complications were compared between two groups. Results In study group, the new vessels completely vanished in 35 eyes(92.1%) and few new vessels remained in 3 eyes(7.9%), while no case had completed neovascular vanishment in control group. At 1 d, 7d, 1 month, 3 month and 6 month after treatment, the intraocular pressure in study group was significantly lower than that in control group(all P<0.05). At 6 month after treatment, the vision of study group was significantly better than that of control group(P<0.05). There were no significant differences in incidence of anterior chamber exudation, low intraocular pressure and corneal edema between two groups(all P >0.05). Compared with control group, the incidence of bleeding of anterior chamber and drainage tube blocking in study group was significantly lower less than that in control group(both P <0.05). Conclusion Ranibizumab combined with FP-7 Ahmed valve implantation is safe and effective in treatment of neovascular glaucoma.
Objective To evaluate the efficacy of ranibizumab combined with FP-7 Ahmed valve implantation for neovascular glaucoma(NVG). Methods Seventy patients(73 eyes) with NVG were assigned in two groups: 34 cases(35 eyes)were treated with FP-7 Ahmed valve implantation(control group) and 36 cases(38 eyes) were treated with FP-7 Ahmed valve implantation and ranibizumab(study group). The neovascular vanishment, intraocular pressure, vision and complications were compared between two groups. Results In study group, the new vessels completely vanished in 35 eyes(92.1%) and few new vessels remained in 3 eyes(7.9%), while no case had completed neovascular vanishment in control group. At 1 d, 7d, 1 month, 3 month and 6 month after treatment, the intraocular pressure in study group was significantly lower than that in control group(all P<0.05). At 6 month after treatment, the vision of study group was significantly better than that of control group(P<0.05). There were no significant differences in incidence of anterior chamber exudation, low intraocular pressure and corneal edema between two groups(all P >0.05). Compared with control group, the incidence of bleeding of anterior chamber and drainage tube blocking in study group was significantly lower less than that in control group(both P <0.05). Conclusion Ranibizumab combined with FP-7 Ahmed valve implantation is safe and effective in treatment of neovascular glaucoma.
引文
[1]Chen S,Zhou M,Wang W,et al.Levels of angiogenesis-related vascular endothelial growth factor family in neovascular glaucoma eyes[J].Acta Ophthalmologica,2015,93(7):556-560.doi:10.1111/aos.12624.
[2]Arcieri ES,Paula JS,Jorge R,et al.Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation:2‐year follow‐up[J].Acta Ophthalmologica,2015,93(1):1-6.doi:10.1111/aos.12608.
[3]Min T,Yang F,Ying W,et al.Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma[J].Bmc Ophthalmology,2016,16(1):7-10.doi:10.1186/s12886-016-0183-7.
[4]Ma KT,Yang JY,Kim JH,et al.Surgical results of Ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma[J].Journal of Glaucoma,2012,21(5):331-336.doi:10.1097/IJG.0b013e31820e2fd0.
[5]Nagendran ST,Finger PT.Anti-VEGF intravitreal bevacizumab for radiation-associated neovascular glaucoma[J].Ophthalmic Surgery Lasers&Imaging Retina,2015,46(2):201-203.doi:10.3928/23258160-20150213-08.
[6]徐晓萍,许霞,吴国海.两种方法治疗难治性青光眼疗效分析[J].浙江医学,2010,32(4):572-573.
[7]张一,刘哲丽,张含,等.玻璃体内注射雷珠单抗治疗病理性近视脉络膜新生血管[J].国际眼科杂志,2015,2(3):381-385.doi:10.3980/j.issn.1672-5123.2015.3.01.
[8]刘勇,平功勋.贝伐单抗与雷珠单抗联合Ahmed阀植入治疗NVG的对照研究[J].国际眼科杂志,2015,15(12):2114-2119.doi:10.3980/j.issn.1672-5123.2015.12.24.
[9]Netland PA,Ishida K,Boyle JW.The Ahmed Glaucoma Valve in patients with and without neovascular glaucoma[J].Journal of Glaucoma,2010,19(9):581-586.doi:10.1097/IJG.0b013e3181ca7f7f.
[10]Yildirim N,Yalvac IA,Ozer A,et al.A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma:a long-term follow-up[J].Journal of Glaucoma,2009,18(3):192-195.doi:10.1097/IJG.0b013e31817d235c.
[11]Shen CC,Salim S,Du H,et al.Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma[J].Clinical Ophthalmology,2011,1(2):281-286.doi:10.2147/OPTH.S16976.
[12]张少维,黄毅,李琴,等.全视网膜光凝联合Ahmed引流阀植入术及雷珠单抗玻璃体腔注射治疗新生血管性青光眼[J].中国眼耳鼻喉科杂志,2017,17(1):33-35.doi:10.14166/j.issn.1671-2420.2017.07.010.
[13]Luke J,Nassar K,Luke M,et al.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma-results from a prospective interventional case series[J].Graefe's Archive for Clinical and Experimental Ophthalmology,2013,251(10):2403-2413.doi:10.1007/s00417-013-2428-y.
[14]Elmekawey H,Khafagy A.Intracameral ranibizumab and subsequent mitomycin C augmented trabeculectomy in neovascular glaucoma[J].Journal of Glaucoma,2014,23(7):437-440.doi:10.1097/IJG.0b013e3182946398.
[15]徐金华,王育良,林琳,等.玻璃体腔注射雷珠单抗联合Ahmed引流阀植入治疗新生血管性青光眼的疗效[J].江苏医药,2015,41(21):2550-2552.
[2]Arcieri ES,Paula JS,Jorge R,et al.Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation:2‐year follow‐up[J].Acta Ophthalmologica,2015,93(1):1-6.doi:10.1111/aos.12608.
[3]Min T,Yang F,Ying W,et al.Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma[J].Bmc Ophthalmology,2016,16(1):7-10.doi:10.1186/s12886-016-0183-7.
[4]Ma KT,Yang JY,Kim JH,et al.Surgical results of Ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma[J].Journal of Glaucoma,2012,21(5):331-336.doi:10.1097/IJG.0b013e31820e2fd0.
[5]Nagendran ST,Finger PT.Anti-VEGF intravitreal bevacizumab for radiation-associated neovascular glaucoma[J].Ophthalmic Surgery Lasers&Imaging Retina,2015,46(2):201-203.doi:10.3928/23258160-20150213-08.
[6]徐晓萍,许霞,吴国海.两种方法治疗难治性青光眼疗效分析[J].浙江医学,2010,32(4):572-573.
[7]张一,刘哲丽,张含,等.玻璃体内注射雷珠单抗治疗病理性近视脉络膜新生血管[J].国际眼科杂志,2015,2(3):381-385.doi:10.3980/j.issn.1672-5123.2015.3.01.
[8]刘勇,平功勋.贝伐单抗与雷珠单抗联合Ahmed阀植入治疗NVG的对照研究[J].国际眼科杂志,2015,15(12):2114-2119.doi:10.3980/j.issn.1672-5123.2015.12.24.
[9]Netland PA,Ishida K,Boyle JW.The Ahmed Glaucoma Valve in patients with and without neovascular glaucoma[J].Journal of Glaucoma,2010,19(9):581-586.doi:10.1097/IJG.0b013e3181ca7f7f.
[10]Yildirim N,Yalvac IA,Ozer A,et al.A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma:a long-term follow-up[J].Journal of Glaucoma,2009,18(3):192-195.doi:10.1097/IJG.0b013e31817d235c.
[11]Shen CC,Salim S,Du H,et al.Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma[J].Clinical Ophthalmology,2011,1(2):281-286.doi:10.2147/OPTH.S16976.
[12]张少维,黄毅,李琴,等.全视网膜光凝联合Ahmed引流阀植入术及雷珠单抗玻璃体腔注射治疗新生血管性青光眼[J].中国眼耳鼻喉科杂志,2017,17(1):33-35.doi:10.14166/j.issn.1671-2420.2017.07.010.
[13]Luke J,Nassar K,Luke M,et al.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma-results from a prospective interventional case series[J].Graefe's Archive for Clinical and Experimental Ophthalmology,2013,251(10):2403-2413.doi:10.1007/s00417-013-2428-y.
[14]Elmekawey H,Khafagy A.Intracameral ranibizumab and subsequent mitomycin C augmented trabeculectomy in neovascular glaucoma[J].Journal of Glaucoma,2014,23(7):437-440.doi:10.1097/IJG.0b013e3182946398.
[15]徐金华,王育良,林琳,等.玻璃体腔注射雷珠单抗联合Ahmed引流阀植入治疗新生血管性青光眼的疗效[J].江苏医药,2015,41(21):2550-2552.