中华眼外伤职业眼病杂志2024，Vol.46Issue(7) ：530-535.DOI:10.3760/cma.j.cn116022-20240419-00075

阿柏西普与雷珠单抗联合小梁切除术治疗新生血管性青光眼的效果比较

Comparison on the efficacy between the intravitreal injection of aflibercept and ranibizumab combined with trabeculectomy in the treatment of neovascular glaucoma

刘杨 曹嵘
中华眼外伤职业眼病杂志2024，Vol.46Issue(7) ：530-535.DOI:10.3760/cma.j.cn116022-20240419-00075
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阿柏西普与雷珠单抗联合小梁切除术治疗新生血管性青光眼的效果比较

Comparison on the efficacy between the intravitreal injection of aflibercept and ranibizumab combined with trabeculectomy in the treatment of neovascular glaucoma

刘杨 1曹嵘1
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作者信息

  • 1. 商丘市第一人民医院眼科,商丘 476100
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摘要

目的 比较阿柏西普与雷珠单抗联合小梁切除术治疗新生血管性青光眼(NVG)的临床效果.方法 前瞻性队列研究.纳入2022年1月至2023年12月商丘市第一人民医院收治的NVG患者100例(100眼),通过随机数字表法分为两组:A组50例(50眼),术前1周玻璃体内注射阿柏西普后行小梁切除术;B组50例(50眼),术前1周玻璃体内注射雷珠单抗后行小梁切除术,比较两组患者的眼压、最佳矫正视力(BCVA,logMAR)、注射次数、新生血管消退及复发情况.结果 两组首次注药术前[A组:(52.46±8.85)mmHg(1 mmHg=0.133 kPa);B组:(52.84±8.67)mmHg]至小梁切除术后3 个月[A组:(14.37±5.16)mmHg;B组:(14.58±5.20)mmHg]眼压均逐渐下降,小梁切除术术后6 个月眼压[A组:(15.52±6.49)mmHg;B组:(15.40±6.55)mmHg]略有上升,眼压在A组、B组各个时间点比较中差异有统计学意义(F时间=721.30,P<0.001),两组小梁切除术后 6 个月眼压明显低于玻璃体内首次注药术前(A组:t=23.80,P<0.001;B组:t=24.36,P<0.001);两组首次注药术前(A组:2.48±0.64;B组:2.50±0.60)至小梁切除术后 1 周(A组:1.34±0.42;B组:1.47±0.44)BCVA均改善,小梁切除术后 6 个月(A组:1.63±0.54;B组:1.68±0.52)BCVA数值均略有上升,BCVA在A组、B组各个时间点比较中差异有统计学意义(F时间=96.80,P<0.001).两组小梁切除术后 6 个月BCVA明显优于玻璃体腔首次注药术前(A组:t=7.45,P<0.001;B组:t=7.30,P<0.001);注药术后 1 周两组新生血管消退率(A组:84.00%,42/50;B组:80.00%,40/50)经比较差异无统计学意义(A组:χ2=0.27,P=0.603),随访期间两组新生血管复发情况(A组:10.00%,5/50;B组:16.00%,8/50)经比较差异无统计学意义(χ2=0.80,P=0.372),两组平均注药次数[A组:(1.82±0.47)次;B组:(1.68±0.52)次]经比较差异无统计学意义(t=1.41,P=0.161).结论 小梁切除术术前玻璃体内注射阿柏西普与雷珠单抗均能有效降低NVG患者眼压,改善BCVA水平,促进新生血管消退并减少其复发.

Abstract

Objective To compare the clinical efficacy between the intravitreal injection of aflibercept and ranibizumab combined with trabeculectomy in the treatment of neovascular glaucoma(NVG).Methods This study was a prospective cohort study.A total of 100 eyes of 100 NVG patients in the Shangqiu First People's Hospital from Jan.2022 to Dec.2023 were selected and they were divided into two groups by random number table method:50 patients(50 eyes)in group A received intravitreal injection of aflibercept at 1 week before surgery,followed by trabeculectomy;50 patients(50 eyes)in group B received intravitreal injection of ranibizumab followed by trabeculectomy one week later.Intraocular pressure,best corrected visual acuity(BCVA,logMAR),number of injections,regression of neovascularization,and recurrence were compared between the two groups.Results The intraocular pressure of both groups gradually decreased from the time before first medication injection surgery[group A:(52.46±8.85)mmHg(1 mmHg=0.133 kPa);group B:(52.84±8.67)mmHg]to 3 months after trabeculectomy[group A:(14.37±5.16)mmHg;group B:(14.58±5.20)mmHg].Intraocular pressure slightly increased from 3 months to 6 months after trabeculectomy[group A:(15.52±6.49)mmHg;group B:(15.40±6.55)mmHg],there was a statistically significant difference in intraocular pressure between group A and group B at various time points(F=721.30,P<0.001).At 6 months after trabeculectomy,the intraocular pressure of both groups was significantly lower than that before the first intravitreal injection(group A:t=23.80,P<0.001;group B:t=24.36,P<0.001).The best corrected visual acuity(logMRA)of both groups decreased from the time before first medication injection surgery(group A:2.48±0.64;group B:2.50±0.60)to one week after trabeculectomy(group A:1.34±0.42;group B:1.47±0.44).Best corrected visual acuity slightly increased from 1 week to 6 months after trabeculectomy(group A:1.63±0.54;group B:1.68±0.52),and the difference in BCVA between group A and group B at various time points was statistically significant(F=96.80,P<0.001).The BCVA at 6 months after trabeculectomy in both groups was significantly better than that before the first intravitreal injection(group A:t=7.45,P<0.001;group B:t=7.30,P<0.001);The difference of regression of neovascularization at 1 week after injection between the two groups(group A:84.00%,42/50;group B:80.00%,40/50)had no statistical significance(χ2=0.27,P=0.603).During the follow-up period,there was no statistically significant difference in the recurrence of neovascularization between the two groups(group A:10.00%,5/50;group B:16.00%,8/50)(χ2=0.80,P=0.372).The average number of injections between the two groups[group A:(1.82±0.47)times;group B:(1.68±0.52)times]showed no statistically significant difference after comparison(t=1.41,P=0.161).Conclusion Before trabeculectomy,intravitreal injection of aflibercept and ranibizumab can effectively reduce intraocular pressure in patients with NVG,improve the level of best corrected visual acuity,promote the regression of neovascularization and reduce its recurrence.

关键词

阿柏西普/雷珠单抗/小梁切除术/新生血管性青光眼/临床疗效

Key words

Aflibercept/Ranibizumab/Trabeculectomy/Neovascular glaucoma/Clinical efficacy

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出版年

2024
中华眼外伤职业眼病杂志
中华医学会

中华眼外伤职业眼病杂志

影响因子：0.622
ISSN：2095-1477
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