| Background:Neovascular glaucoma(NVG)is an intractable glaucoma occurs to ocular ischemic diseases,such as central retinal vein occlusion、diabetic retinopathy、branch retinal vein occlusion secondarily.Traditional anti-glaucoma surgery in patients with NVG is infeasible because there is a large abundance of neovessels on the surface of the iris and angle,and damaging these vessels can lead to intraoperative or inoperative hyphema.Retinal ischemia has been shown to upregulate the expression of vascular endothelial growth factor(VEGF),VEGF play an important role in the process of intraocular angiogenesis and NVG.Anti-vascular endothelial growth factor agents such as bevacizumab or ranibizumab can inactivate VEGF by combining with VEGF reporters,therefore these agents can be served as a useful adjuctive to the therapy of NVG via its anti-angiogenic and anti-fibrotic properties.Recent studies showed that glaucoma filtration surgery combined with intravitreal injection of bevacizumab or ranibizumab as a new therapy of NVG is safety and efficacy.However,the efficacy of intravitreal injection of conbercept for NVG is still explorating.Objective:To observe the efficacy and safety of intravitreal injection of conbercept combined trabeculectomy and panretinal photocoagulation in the treatment of NVG,provide a new method for the clinical treatment of NVG.Methods:It was a prospective,interventional case study.30 patients(29 eyes)with NVG were included.28 eyes were initially injected with conbercept into vitreous,then trabeculectomy and panretinal photocoagulation peformed,it is one year follow-up.The best-corrected visual acuity、intraocular pressure、the number of anti-glaucoma medicines of NVG patients were detected and the surface of iris neovascularization regression after intravitreal injection and bleb observation after trabeculectomy were observed respectively before and after surgery in different time points,postoperative complications and treatment means were evaluated.Light microscopy and transmission electron microscopy were used to observe the surgically excised tissue,which showing iris neovascularization regression and the structure of trabecular meshwork;enucleation was performed for 2 eyes,light microscopy of the surgically excised tissue was taken as the hispathology controls.Results:Afterintravitrealinjection ofconbercept,the surfaceofiris neovascularization was rapidly regression,and iris neovascularization recurred in 1eye during the follow-up period.There was a significant difference between the preoperative and postoperative intraocular pressure、the best corrected visual acuity(F=494.161,p=0.000,F=42.967,p=0.000).Intraocular pressure decreased gradually from 47.8±10.8mmHg to 17.2±4.2mmHg at the time of 1 year follow-up and the difference was statistically significant(p=0.000).The best corrected visual acuity was increased from 2.1±0.9 to 1.4±1.2,but the difference was not statistically significant(p>0.05).The number of anti-glaucoma drugs of between preoperative and postoperative were statistically significant difference(χ~2=120.800,p=0.000),at 1years of postoperation the number of anti-glaucoma agents was 0(0,1)which is less than preoperative 3(3,4),and the differsnce is significant(p=0.000).One year after surgery,24 eyes(intraocular pressure less than 21mmHg)were assessed successful surgery,4 eyes failed,the surgical success rate was 85.7%.During follow-up,the dispersion scope of filtering bled was big、flat and had a good filtration function.Regression of neovascularization in the surface of iris and thin-walled vessels in the iris stroma in specimens after intravitreal conbercept were revealed by light microscopy.Neovascularization decreased、endothelial cell degeneration and vascular occlusion or cavity in the iris stroma in the conbercept-treatment specimens were revealed by transmission electron microscopy.Conclusion:For patients with NVG,intravitreal injection with conbercept can make iris neovascularization significantly regress、reduce intraoperative and postoperative complications,and after trabeculectomy combined with panretinal photocoagulation is performed,which can effectively control IOP and preserve visual function,down the process of filtration channel sacrring,maintain a good filtration function,improve the success rate of surgery. |
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