Observation On The Efficacy Of Comprehensive Treatment Of Neovascular Glaucoma

Objective To observe the efficacy of comprehensive treatment of neovascular glaucoma and provide a reference for the treatment of neovascular glaucoma.Methods The data of 102 eyes of 98 cases with neovascular glaucoma from Sep.2014 to Oct.2016 in the Department of Ophthalmology of Glaucoma in the First Affiliated Hospital of Zhengzhou University were enrolled and analyzed retrospectively.All patients were treated with intravitreal injection of bevacizumab.After 1 week,intraocular pressure of 23 eyes(24 eyes)returned below 21 mmHg,then Panretinal photocoagulation was performed,and 75 patients(78 eyes)were treated with trabeculectomy combined with biological amniotic membrane transplantation 1 week after injection,and they underwent panretinal photocoagulation after intraocular pressure fell to normal range 2 weeks.The visual acuity,intraocular pressure,filtering blebs,and complications were recorded before,and 1 day,1 week,1,3,6,9 and 12 months after treatment.Results(1)All or most new vessels of iris disappeared after injection for 2~7 days.(2)Among the 24 eyes of patients without trabeculectomy,the best corrected visual acuity at the last follow-up improved in 17 eyes(70.83%),unchanged in 6 eyes(25.00%),and decreased in 1 eye(4.17%).And 78 eyes of patients with trabeculectomy,the best corrected visual acuity at the last follow-up improved in 27 eyes(34.62%),unchanged in 35 eyes(44.87%),and decreased in 16 eyes(20.51%).(3)For the 24 eyes without trabeculectomy,the last follow-up of intraocular pressure was(18.37±2.58)mmHg,and the preoperative intraocular pressure was(38.56±7.83)mmHg,the difference in intraocular pressure was statistically significant(t=9.96,P<0.05).During the follow-up period,intraocular pressure was controlled successfully in 14 eyes(58.33%),partially in 10 eyes(41.67%),and there was no failure.And for the 78 eyes with trabeculectomy,the last follow-up of intraocular pressure was was(19.24±3.18)mmHg,and the preoperative intraocular pressure was(43.73±9.64)mmHg,the difference in intraocular pressure was statistically significant(t=16.95,P<0.05).During the follow-up period,intraocular pressure was controlled successfully in 48 eyes(61.54%),partially in 26 eyes(33.33%),and failure in 4 eyes(5.13%).(4)At the last follow-up after operation,among the 78 eyes undergoing trabeculectomy,50 cases formed functional filtering blebs(64.10%),and 28 formed nonfunctional filtering blebs(35.90%).(5)All patients had no serious complications such as endophthalmitis,choroidal detachment,and retinal detachment during follow-up.Conclusion(1)Intravitreous injection of bevacizumab combined with PRP can effectively control intraocular pressure of neovascular glaucoma and preserve the visual function.(2)Intravitreous injection of bevacizumab,trabeculectomy combined with biological amniotic membrane transplantation and panretinal photocoagulation can effectively control intraocular pressure of neovascular glaucoma,improve the ischemia and hypoxia status of retinal,and protect the visual function to improve the quality of life.