Clinical Observation Of Anti-VEGF Drugs Combined With Different Surgical Treatments For NVG

Purpose:To study the clinical efficacy of anti-vascular endothelial growth factor drugs combined with different surgical methods for the treatment of neovascular glaucoma,to comprehensively evaluate the role and value of Anti-VEGF in the treatment of NVG,and to provide a theoretical basis for the development of NVG treatment strategies.Methods:A total of 98 patients(105 eyes)diagnosed with neovascular glaucoma at the Affiliated Hospital of Qingdao University from January 2013 to January 2015 were included in the study.The data were retrospectively analyzed and were followed up for 3 to 5 years.The control group(47 eyes in group A,51 eyes)underwent panretinal photocoagulation(PRP)+ combined trabeculectomy and/or pars plana vitrectomy(PPV)and observation group(group B 51 Example 54)Intravitreal injection of anti-VEGF drug+ PRP + compound trabeculectomy and/or PPV.Observe and analyze the total laser photocoagulation points of PRP between the control group and the observation group during the two clinical stages of NVG patients,the best corrected visual acuity(BCVA),preoperative and postoperative At the time of follow-up,IOP,preoperative time,complications,duration of hyphema after operation,postoperative 5-Fluoruracil(5-Fu)injection,number of filtering blebs after acupuncture,surgery Post-OCT examination of changes in retinal nerve fiber layer thickness(Circulla retial never fiber layer,cpRNFL)and the number of intravitreous injections of the relationship between the number of intravitreal injections and surgical success rate.All data were statistically analyzed.Results:1.The total laser photocoagulation points of PRP in the observation group were 1724.29 ±109.16 points and 1852.85 ± 100.85 points in NVGⅡ and Ⅲ phases.The total laser photocoagulation points of PRP in the control group at NVGⅡphase and Ⅲ phase were 2005.54 ± 120.94 points and 2242.52 ±209.76 points.The two points were compared and the differences were statistically significant(P 1=0.000,P2=0.000).2.The preoperative BCVA of NVGⅡ and Ⅲ in the observation group was 2.14 ± 0.84 and 2.19 ± 0.86(both calculated as Log MAR).The preoperative BCVA in the control group was 1.89 ± 0.45 and 2.15 ± 0.72 in the NVG II and III phases.There was no significant difference between the two groups(P1=0.233,P2=0.848).At the last follow-up,the BCVA in the NVGⅡ and Ⅲ phases of the observation group was 0.99 ± 0.65 and 1.32 ±0.59,compared with 1.49 ± 0.89 and 1.90 ± 0.82 in the control group.The difference was statistically significant(P1=0.038,P2=0.002).3.In the NVGⅡ and Ⅲ phases,the mean preoperative IOP was 50.05 ± 8.92mmHg and 49.48 ±9.97mmHg in the observation group,and the mean preoperative IOP was 51.23 ± 4.13mmHg and 51.24 ± 4.01mmHg in the control group.No statistical difference was found between the two groups.Significance(P1=0.578,P2=0.378);In the NVGⅡ phase,the mean intraocular pressures of the observation group at follow-up of 3m,6m,1y,and 3y were 14.03 ± 1.62mmHg,15.35 ± 1.76mmHg,15.99 ± 2.18mmHg,and 17.39 ±,respectively;3.38mmHg,the mean intraocular pressure of follow-up 3m,6m,1y and 3y in the control group was 14.99 ± 0.65mmHg,16.74 ± 0.78mmHg,17.08 ± 0.73mmHg,and 19.07 ± 0.96mmHg,respectively,and the differences between the two groups were compared.All were statistically significant(P1=0.015,P2=0.003,P3=0.042,P4=0.005).In the NVG phase Ⅲ,the mean intraocular pressures of the observation group at follow-up of 3m,6m,1y,and 3y were 15.12 ±1.89mmHg,15.82 ±2.56mmHg,16.27 ±2.01mmHg,and 17.73 ± 1.94mmHg respectively in the observation group,and the follow-up was 3m,6m in the control group.The mean intraocular pressures at 1 year and 3 years were 16.12 ± 1.09mmHg,16.98 ± 1.23mmHg,17.27 ± 1.40mmHg,and 19.27 ±1.39mmHg,respectively.The differences between the two groups were statistically significant(P1=0.012,P2= 0.026,P3 = 0.025,P4 = 0.001).At the last follow-up,the average intraocular pressure in the NVGⅡ and Ⅲ phases was higher in the observation group and the control group than in the postoperative 1 year,but it was still significantly lower than before the operation,and the difference was statistically significant(P<0.05).4.In NVGⅡ and Ⅲ,the average preoperative time of observation group was 12.24 ±9.85d and 15.42 ± 10.64d.The average preoperative time of the control group was 17.41 ± 3.25d and 19.48±3.34d.Statistically significant(P1=0.031,P2=0.044).The complications of NVG Ⅱ and Ⅲ patients in the observation group and control group mainly included anterior chamber hemorrhage,filtering bleb scarring,filtration bleb leakage,and shallow anterior chamber.There was no statistically significant difference between the two groups(P=0.179);At the end of the follow-up period,there were no long-term hypotony,retinal detachment,malignant glaucoma,endophthalmitis,and other complications in the observation group and the control group.In the NVGⅡ and Ⅲ stages,the mean duration of hyphema after operation in the control group was 0.68 ± 0.48 and 2.93 ± 1.03d,which were lower than the mean duration of hyphema in the observation group after 3.05 ±1.12 and 4.45 ±0.94d.All had significant statistical significance(P1=0.000,P2=0.000).5.The number of 5-FU injections and aspirations in the NVGⅡ and Ⅲ stages of the observation group were significantly lower in the observation group than in the control group(P<0.05);in the NVGⅡ and Ⅲ phases,the observation group was observed in the observation group.The number of filtration blebs isolated by 5-Fu acupuncture after anti-VEGF drugs was 1.42 ± 0.51 and 1.61 ± 0.50,respectively.The anti-VEGF drugs were 2.33 ± 1.00 and 2.47 ± 0.64 respectively.The difference between the two was statistically significant(P1=0.029,P2=0.000).6.In the observation group,the degree of atrophy at the top,bottom,side of the nose,side of the nose,and average cpRNFL in the NVGⅡ and Ⅲ stages were all lighter than those in the control group.The difference in thickness between the observation group and the control group was statistically significant(P<0.05);In Phase Ⅲ and Ⅲ,the mean cpRNFL atrophy was smaller in the observation group than in the Anti-VEGF drug at each follow-up time,and the difference in thickness was statistically significant(all P<0.01).At the follow-up period of 3 years,the average atrophy of cpRNFL in both the observation group and the control group was getting thinner,but the observation group had a lighter change in the control group,and the difference in thickness was statistically significant(P=0.000).In the success rate of surgery,by the end of the follow-up period,the total success rate of the observation group was 81.50%,and the total success rate of the control group was 78.40%.There was no significant difference between the two groups(Log-rank P=0.723).Conclusions:1.Intravitreal injection of Anti-VEGF drugs is an advantageous aid for NVG surgery.2.In the course of combined trabeculectomy with NVG,combined anti-VEGF drugs can not significantly improve the success rate of surgery,but its long-term efficacy is better than only combined PRP.