摘要
目的通过新生血管性青光眼发病不同时期进行个性化治疗方案的选择，来探讨个性化治疗的疗效和安全性。方法回顾性病例系列研究。对2012年1月至2014年5月在南昌大学第一附属医院眼科诊治的94例94只眼新生血管性青光眼患者的临床资料，所有患者均接受玻璃体腔Lucentis注射ranibizumab（0．5mg／0.05mL），待虹膜新生血管消退后，视病情不同采用个性化治疗方式。根据患者屈光介质情况尽量行全视网膜光凝。随访6个月，观察个性化治疗前后视力、虹膜及房角新生血管情况、眼压及并发症。结果所有患者经玻璃体腔注射Lucentis3-7天后虹膜新生血管消退和（或）大部分消退。视病情不同个性化治疗情况如下：使用抗青光眼药物8只眼，复合式小梁切除术44只眼，玻璃体切割术39只眼（其中联合白内障手术5只眼），睫状体冷凝术3只眼。治疗前平均眼压48．20mmHg，治疗后1周、1月、3月、6月平均眼压分别为18．62、20．78、19．64和17．84mmHg。与治疗前相比均差异有统计学意义（P〈0．05）；治疗后1周、1月、3月、6月平均眼压相比均差异无统计学意义（P〉0．05）。随访6月时，视力较前提高者78只眼，无明显改变者12只眼，视力下降者4只眼，治疗前后视力比较差异有统计学意义（P〈0．05）。手术未出现排斥反应和严重的并发症。结论玻璃体腔注射Lucentis联合全视网膜光凝可使虹膜新生血管迅速消退，改善视网膜缺血状态，并根据患者不同病情制订个性化的治疗方案，有效降低眼压，并发症少，值得临床推广。
Objective To take the personalized treatment on neovascular glaucoma in different periods and evaluate the efficacy and safety of the personalized treatment. Methods Retrospectively analyzed the clinical data of 94 cases （94 eyes） with neovascular glaucoma in our hospital from January 2012 to May 2014. All patients received intravitreal injection of Lucentis （ranibizumab 0.5mg/ 0.05mL）. The different way of treatment as the condition after iris neovascularization subsided and performed the panretinal photocoagulation according to the patient＇s refractive medium before or after surgery was taken. Patients were followed up for 6 months. The visual acuity, the neovascularization of iris and angle, the intraocular pressure and the operation complication were observed after the op- eration. Results All the patients underwent intravitreal injection of Lucentis and iris neovasculariza- tion subsided or largely faded away after 3-7 days. The following as the condition of different per- sonalized treatment were： 8 eyes of glaucoma medication use, 44 eyes of compound trabeculectomy, 39 eyes of vitrectomy （including 5 eyes of cataract operation）, and 3 eyes of ciliary body cryothera- py. The average preoperative IOP was 43.65mmHg, and 1 week, 1 month, 3 months and 6 months average IOP were 18.62mmHg, 20.78mmHg, 19.64mmHg, 17.84mmHg. Compared with the preoperative lOP there were significantly different （P 〈0.05）, and no significant difference （P 〉0.05） among the postoperative 1 week, 1 month, 3 months and 6 months average intraocular pressure. Follow up 6 months, visual acuity improved than before in 78 eyes, no obvious change in 12 eyes, visual acuity decreased in 4 eyes. Visual acuity was statistically significant （P 〈0.05） before and after opera- tion. There were no operation rejection and severe Complications. Conclusions Intravitreal injection of Lucentis combined with panretinal photocoagulation can regress the iris neovascularization and im- prove the state of retinal ischemia. The personalized treatment on neovascular glaucoma in different periods, effectively reduce intraocular pressure and has less complication. It is worth the clinical pro- motion.
出处
《中国实用眼科杂志》
2016年第2期118-121,共4页
Chinese Journal of Practical Ophthalmology
作者简介
通信作者：周琼，Email：qingz-ms@126．com
