新生血管性青光眼聯合治療療效分析

黃 芳，宋彩萍，于 淼

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·臨床報告·

新生血管性青光眼聯合治療療效分析

黃 芳1，宋彩萍1，于 淼2

?METHODS:Twenty-three eyes of 21 patients with neovascular glaucoma were enrolled. The patients of ocular media transparency were treated with intravitreous injection of anti-VEGF drug and PRP combined with filtering surgery. The patients of ocular media opacity were treated with vitrectomy or cataract surgery in the meantime. All cases were followed for 3mo, IOP control were observed after treatment.

?RESULTS:One patient visual acuity improved significantly, all remaining stable or slightly improve visual acuity. All case showed regress at different degree of the iris neovessels. There was significant difference between before and after treatment (P=0.00).

?CONCLUSION:The intravitreous injection of anti-VEGF drug and PRP combined with filtering surgery for neovascular glaucoma provide more rapid control of IOP. It is a better choice of neovascular glaucoma.

目的：觀察抗血管內皮生長因子(vascular endothelial growth factor，VEGF)藥物玻璃體腔內注射及全視網膜光凝(panretinal photocoagulation，PRP)后聯合濾過手術治療新生血管性青光眼的療效。

方法：對21例23眼患者中屈光介質透明者行抗VEGF藥物玻璃體腔內注射及PRP后新生血管消退后行復合式小梁切除術，屈光介質混濁患者行白內障或玻璃體切除術及全視網膜光凝聯合復合式小梁切除術，隨訪3mo，對治療前后眼壓情況進行比較。

結果：患者1例1眼視力提高顯著，其余患者視力穩定或略有提高，所有患者虹膜新生血管均有不同程度消退。治療前后眼壓比較有統計學差異(P<0.01)，所有患者均未出現術中術后嚴重并發癥。

結論：抗VEGF藥物玻璃體腔內注射及PRP清除虹膜新生血管后聯合濾過手術可以較快、較好地控制眼壓，可有效治療新生血管性青光眼。

眼壓；新生血管性青光眼；血管內皮生長因子抑制劑；玻璃體腔注射；小梁切除術

引用：黃芳，宋彩萍，于淼.新生血管性青光眼聯合治療療效分析.國際眼科雜志2016;16(12):2311-2313

0引言

新生血管性青光眼是繼發于視網膜疾病的一種難治性青光眼，占亞洲青光眼的0.7%～5.1%[1-2]，系由于各種原因造成視網膜缺血缺氧，產生血管內皮生長因子(vascular endothelial growth factor，VEGF)[3-5]，進而導致虹膜產生新生血管叢阻塞房角小梁網，引起患者眼壓增高。除此之外，血管膜收縮可導致虹膜前粘連、房角關閉，眼壓進一步升高。因此，對該類型青光眼，不論是藥物還是傳統手術均效果不佳[6-8]。我院采用玻璃體腔內注射抗VEGF聯合全視網膜光凝后(panretinal photocoagulation，PRP)及傳統濾過手術取得良好效果，現報告如下?！?br>