| OBJECTIVE:To investigate the clinical efficacy of intravitreal injection of ranibizumab combined with trabeculectomy and panretinal photocoagulation(PRP)for neovascular glaucoma(NVG).METHODS:Randomized controlled clinical research methods.Twenty-four patients(24 eyes)with angle-closure NVG diagnosed in the First Affiliated Hospital of Nanchang University were treated with intravitreal injection of razumab combined with trabeculectomy and PRP(triple therapy)treatment group(experimental group).Twenty patients(20 eyes)matched in sex and age were selected for trabeculectomy combined with PRP(control group).Both groups of patients were angle-closure NVG patients,which met the discharge criteria.Perfect preoperative best corrected visual acuity,intraocular pressure,slit lamp and fundus examination.The experimental group was treated with trabeculectomy 3-5 days after intravitreal injection of drugs.According to the corneal condition,the whole course could be peeped into the fundus of the eye,and the whole retina laser photocoagulation was improved within one month.The control group was treated with trabeculectomy,and the whole retina laser photocoagulation was improved within one month.The changes of intraocular pressure in 1 month,3 months and 6 months after operation,the best corrected visual acuity,the success rate of treatment,the disappearance of iris neovascularization and complications were observed.The criteria for judging the success of treatment in both groups were: after 6 months of treatment,intraocular pressure ranged from 6 to 21 mmHg after using or not using anti-glaucoma drugs.The failure criterion was that the intraocular pressure was still higher than 21 mmHg after 6 months of treatment with the maximum dose of anti-glaucoma drugs.Treatment success rate = number of successful cases / total cases.SPSS 21.0 software was used for statistical analysis.Independent sample t test was used for age comparison and intraocular pressurecomparison between groups.Paired t test was used for intraocular pressure changes before and after treatment.The data standard was mean(+standard deviation(+s).Chi-square test(2)and Fisher exact test were used for comparison of gender,primary disease,best corrected visual acuity changes and treatment success rate between groups.The difference was statistically significant with P < 0.05.RESULTS:1.There was no significant difference in age,intraocular pressure,sex and primary disease between the two groups before treatment.2.The intraocular pressure of NVG patients in the two groups decreased after treatment for 1 month,3 months and 6 months.The intraocular pressure of triple therapy after treatment(15.30+5.33 mmhg,14.88+4.44 mmhg,13.22+5.98 mmHg for1 month,3 months and 6 months respectively)was lower than that of the control group(1 month,3 months and 6 months respectively).Six months were divided into18.50(+4.49 mmhg),17.50(+3.82 mmhg)and 18.17(+5.48 mmhg),with significant difference(P<0.05).3.The number of eyes retaining original vision and improving vision in the two groups was 22/24(91.7%)and 13/20(65%)(Fisher exact test,P=0.035),respectively.The difference was statistically significant.4.There was no significant difference in the treatment success rate between the two groups [91.7%(22/24)of the triple therapy group and 85%(17/20)of the control group](Fisher exact test,P=0.411),but the experimental group was slightly higher than the control group.5.The iris neovascularization disappeared within 3-5 days after the injection of Leizhumab in all eyes of the triple therapy group.At the time of final follow-up,there were no complications such as eye atrophy in the triple therapy group.CONCLUSION:1.Both treatments can effectively reduce intraocular pressure and preserve visual function.2.The triple therapy of anti-VEGF combined with trabeculectomy and PRP for NVG can significantly reduce intraocular pressure,eliminate neovascularization,retain visual function,improve the success rate of treatment,and reduce adverse reactions and complications. |
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