CAJ | 학술논문

目的观察玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入治疗新生血管性青光眼(NVG)的术后疗效和并发症.方法回顾性临床病例对照研究.选择新乡医学院第一附属医院眼科在2007年至2008年2月间接受过玻璃体腔注射Bevacizumab 0.05 mL/1.25 mg和Ahmed青光眼阀植入术的NVG患者,术前及术后定期随访检查,记录抗青光眼药物数量、Snellen视力、Godmann压平式眼压计测量的IOP等项目.手术成功标准:术后IOP处于6～21 mm Hg范围内,不再使用或不需额外增加抗青光眼药物治疗,不需进一步抗青光眼手术治疗,术眼视力未丧失光感.结果纳入分析35例(35只眼),随访时间(24.6±14.2)月.Ahmed青光眼阀植入术后IOP比术前降低(P＜0.01),其中术前、术后6月、1年和3年分别为(44.9±4.8)mm Hg、(18.2±4.0)mm Hg、(15.5±3.3)mm Hg和(9.8±2.6)mm Hg(1 mm Hg=0.133 kPa);抗青光眼药物数量术后较术前减少(P＜0.01),其中术前、术后6月、1年和3年分别为(3.3±0.5)种、(0.9±0.5)种、(0.8±0.9)种和(0.8±0.6)种.最后一次随访时,视力较术前保持稳定19例(54.3%),改善4例(11.4%),下降12例(34.3%),丧失光感3例(8.6%).经3年随访,失败病例7例(20.0%).经Ka-plan-Meier生存分析,术后1年、2年、3年累计生存率分别为82.9%、74.1%和71.0%.经Cox逐步回归分析,术前视力较差(＜20/400)与术后生存时间具有相关性(RR=3.571,P＜0.05).术后并发症8例(22.9%),其中前房出血2例(5.7%),脉络膜渗液2例(5.7%),其余并发症较少见,未发生需要取出引流阀的并发症.结论玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入术安全有效,可作为新生血管性青光眼临床治疗方法之一.
목적 관찰파리체강주사Bevacizumab연합Ahmed청광안벌식입치료신생혈관성청광안(NVG)적술후료효화병발증.방법 회고성림상병례대조연구.선택신향의학원제일부속의원안과재2007년지2008년2월간접수과파리체강주사Bevacizumab 0.05 mL/1.25 mg화Ahmed청광안벌식입술적NVG환자,술전급술후정기수방검사,기록항청광안약물수량、Snellen시력、Godmann압평식안압계측량적IOP등항목.수술성공표준:술후IOP처우6～21 mm Hg범위내,불재사용혹불수액외증가항청광안약물치료,불수진일보항청광안수술치료,술안시력미상실광감.결과 납입분석35례(35지안),수방시간(24.6±14.2)월.Ahmed청광안벌식입술후IOP비술전강저(P＜0.01),기중술전、술후6월、1년화3년분별위(44.9±4.8)mm Hg、(18.2±4.0)mm Hg、(15.5±3.3)mm Hg화(9.8±2.6)mm Hg(1 mm Hg=0.133 kPa);항청광안약물수량술후교술전감소(P＜0.01),기중술전、술후6월、1년화3년분별위(3.3±0.5)충、(0.9±0.5)충、(0.8±0.9)충화(0.8±0.6)충.최후일차수방시,시력교술전보지은정19례(54.3%),개선4례(11.4%),하강12례(34.3%),상실광감3례(8.6%).경3년수방,실패병례7례(20.0%).경Ka-plan-Meier생존분석,술후1년、2년、3년루계생존솔분별위82.9%、74.1%화71.0%.경Cox축보회귀분석,술전시력교차(＜20/400)여술후생존시간구유상관성(RR=3.571,P＜0.05).술후병발증8례(22.9%),기중전방출혈2례(5.7%),맥락막삼액2례(5.7%),기여병발증교소견,미발생수요취출인류벌적병발증.결론 파리체강주사Bevacizumab연합Ahmed청광안벌식입술안전유효,가작위신생혈관성청광안림상치료방법 지일.
Objective To explore the efficacy and complication of intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma (NVG). Methods NVG patients received the treatment of intravitreal bevacizumab 0.05mL/1.25mg and Ahmed glaucoma valve implantation were retrospectively selected. Subjects received ocular examinations before operation and routine follow-ups after operation, and information including the number of anti-glaucoma medications,Snellen visual acuity and IOP measured by Goldmann applanation tonometer was recorded. Success was defined as an IOP between 6-2lmmHg, without any or with no more additional anti-glaucoma medications, no need of additional glaucoma surgery, and none loss of light perception. Results Thirty-five cases (35eyes) were included and follow up time was 24.6:± 14.2m. Afier Ahmed valve implantation, IOP was decreased compared with pre-IOP (P <0.01), of which were 44.9± 4.8mmHg (pre-op),.18.2± 4.0mmHg (6 m), 15.5± 3.3mmHg (1 y) and 9.8± 2.6mmHg (3 y). The number of anti-glaucoma medications was decreased compared with pre-number (P ＜0.01), of which were 3.3± 0.5(pre-op), 0.9± 0.5 (6 m), 0.8± 0.9 (1 y) and 0.8± 0.6 (3 y). At last follow up, there were 19 cases (54.3%) with stable visual acuity, 4 cases (11.4%) with visual improvement, 12 cases (34.3%) with worse visual acuity, 3 (8.6%) loss light perception. There were 7 cases (20.0%) failed during 3-year follow up period. The cumulative survival rates were 82.9% (1 y), 74.1% (2 y) and 71.0%(3 y) respectively by Kaplan-Meier sruvival analysis. Cox stepwise regression analysis found that the survival time was significant associated with the preop-visual acuity ＜2/400 (RR=3.571, P ＜0.05). Post-op complications occurred in 8 eyes (22.9%), of which hyphema in 2 eyes (5.7%), choroidal effusion in 2 eyes (5.7%). Other complications occurred infrequently and implants were not removed in any of the patients. Conclusions Being safe and effective, the procedure of intravitreal bevacizumab and Ahmed glaucoma valve implantation should be one of treatments to NVG.