| BackgroundNeovascular glaucoma(NVG)is a kind of refractory glaucoma with high blindness rate and secondary to eye diseases or systemic diseases.The main etiology of NVG is that the ischemia and hypoxia of retina lead to the over secretion of Vascular endothelial growth factor(VEGF)in vitreous cavity and aqueous humor,and promote the generation of new blood vessels on iris surface and angle.In recent years,the incidence rate of NVG has gradually increased.There is no recognized effective treatment at home and abroad.Traditional anti-glaucoma surgery includes filtering operation,such as trabeculectomy,which often fails because of the failure to treat fundus diseases and the large number of ocular new blood vessels in NVG patients.Patients often suffer from high intraocular pressure and pain,and often end up with enucleation.At present,intravitreal injection of anti-VEGF drugs to treat ophthalmopathy with high VEGF concentration as the main cause has been recognized by experts at home and abroad.Conbercept,a recombinant fusion protein,can inhibit angiogenesis by down regulating the expression of VEGF.However,the effective concentration of anti-VEGF drugs remained in the eyes for a short time,and the neovascularization membrane in the angle of the eyes of NVG patients did not disappear,the trabecular meshwork did not open,and the intraocular pressure could not be continuously reduced.In this study,we used intravitreal injection of conbercept combined with trabeculectomy,cyclocryotherapy or panretinal photocoagulation to treat NVG of different clinical stages.The treatment can save the patient’s vision or eyeballs,and it also provides a new idea for the treatment of NVG.ObjectiveTo explore the efficacy and safety of conbercept in the combined treatment of NVG.Methods38 patients(38 eyes)with NVG were selected from the Third Affiliated Hospital of Xinxiang Medical University from January 2017 to December 2018,including 15 patients(15 eyes)with open-angle glaucoma and 23 patients(23 eyes)with closed-angle glaucoma.There were 21 males and 17 females,aged 40-84 years old,with an average age of(57.65 ± 6.76)years.The primary disease was diabetic retinopathy in 20 cases,central retinal vein occlusion in 14 cases,and other causes in 4 cases.The best corrected visual acuity of all patients before treatment was that 2 cases without light sense,21 cases with light sense and 15 cases with manual vision of 0.3.According to the clinical stage of NVG,they were divided into two groups and treated with different treatment schemes.In open-angle glaucoma group(15 cases,15 eyes),trabeculectomy was performed 5-7 days after intravitreal injection of anti-VEGF drugs and panretinal photocoagulation(PRP)was given after trabeculectomy.In closed-angle glaucoma group(23 cases,23 eyes),trabeculectomy and cyclocryotherapy were performed 5-7 days after intravitreal injection of anti-VEGF drugs.all operations were performed by the same chief physician.The patients were followed up for six months after discharge.The clinical data of the patients were collected,including the success rate of operation,the regression of neovascularization,the condition of filtering bleb,the change of vision,the effect of intraocular pressure control,the use of anti-glaucoma drugs,and the postoperative complications.All data were analyzed by spss25.0.Results1.Open-angle glaucoma group: The mean intraocular pressure 3 days after injection was(25.81 ± 5.01)mmHg lower than that before injection [(30.04 ± 4.59)mmHg].The mean intraocular pressure were(15.51 ± 4.46)mmHg,(17.34 ± 2.81)mmHg,(17.75±2.39)mmHg,and(17.81±2.58)mmHg 7 days,1,3 and 6 months after operation respectively,which were significantly lower than that before operation[(26.16±4.87)mmHg].The differences were statistically significant(P < 0.05).There were(1.22 ± 0.94),(1.60 ± 1.12)and(1.07 ± 1.10)kinds of anti-glaucoma drugs used 7 days,1 month and 3 months after operation respectively,which were significantly lower than that before operation[(4.00 ± 0.85)],and the difference was statistically significant(P < 0.05).The recurrence rate of NVG was 13.33%.2.Closed-angle glaucoma group:The mean intraocular pressure was(35.16 ± 5.15)mmHg on the third day after injection,which was lower than that before injection[(42.21 ± 6.72)mmHg].The mean intraocular pressure was(13.51 ± 3.96)mmHg,(14.84 ± 5.81)mmHg,(15.85 ± 4.16)mmHg,(16.01 ± 4.41)mmHg 7 days,1,3 and 6 months after operation respectively,which were significantly lower than that before operation [(37.18±5.77)mmHg].The differences were statistically significant(P < 0.05).There were(1.13±1.22),(1.39±0.99),(0.83±0.72)kinds of anti-glaucoma drugs used 7 days,1 month and 3 months after operation respectively,which were significantly lower than that before operation[(4.39±0.72)],and the differences were statistically significant(P < 0.05).The complication rate was 8.70%.3.There was no significant difference in complete regression rate of iris neovascularization between open-angle group and closed-angle group(P > 0.05).In open-angle group and closed-angle group,the proportion of patients who did not need to use anti-glaucoma drugs 6 months after operation was 73.33% and 60.86% respectively.The failure rates of filtering blebs were 33.33% and 43.48% respectively.The success rates were 86.67% and 91.30% respectively.The proportion of unchanged and improved vision was 73.33% and 91.30% respectively.Conclusions1.In the open-angle stage of NVG patients,conbercept + trabeculectomy + PRP can effectively reduce the intraocular pressure,save the vision of patients,and has high efficiency and safety.2.In the closed-angle stage of NVG patients,conbercept + trabeculectomy combined with cyclocryotherapy can reduce the pain of patients,reduce the economic burden of patients to a certain extent,avoid enucleation in the treatment,and the incidence of complications is low. |
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