Clinical Observation Of Anti-VEGF And Panretinal Photocoagulation Combined With Trabeculectomy And Ahmed Drainage Valve Implantation On Neovascular Glaucoma

Objective Observing clinical observation and the influence of corneal endothelial cells of anti-VEGF and panretinal photocoagulation combined with trabeculectomy and Ahmed drainage valve implantation on neovascular glaucoma.Methods All patients were divided into resection group(n=34 cases)and implantation group(n=33 cases)according to different conditions,treatment methods and patients'wishes.Patients in the resection group received anti-VEGF and total retinal photocoagulation combined with trabeculectomy,and patients in the implantation group received anti-VEGF and total retinal photocoagulation combined with Ahmed drainage valve implantation.Observe the basic conditions of the two groups of patients,intraocular pressure before treatment and 1w,4w and 12w after treatment,the formation of postoperative filter bubbles,visual acuity before treatment and 1w,4w and 12w after treatment,clinical curative effect,iris neovascularization after treatment,complications occurred during treatment,corneal endothelial cell condition before treatment and 1w,4w and 12w after treatment,included corneal endothelial cell density,cell area,hexagon cell percentage(6A),cell area variation coefficient.Results 1.There were no statistically significant differences in the basic preoperative conditions of the two groups,such as age,sex ratio,preoperative intraocular pressure,types of drugs for lowering intraocular pressure before operation(P>0.05),indicating that the two groups were comparable.2.Postoperative intraocular pressure of 1w,4w and 12w in the two groups were statistically different from that before operation respectively(P<0.05).3.There was no significant difference between the two groups in functional filtration bubble(?2=0.463,P>0.05).4.Postoperative visual acuity of 1w,4w and 12w in the two groups were statistically different from that before operation respectively(P<0.05).5.The success rate were 100%in both groups.6.Cell area:There was no significant difference between the two groups before,1w,4w and 12w after operation.In the resection group.There was no significant difference in postoperative 1w,4w and 12w compared with preoperative.There was a significant difference between 12w after operation and preoperative in implantation group.There was no significant difference between 1w,4w after operation and before operation Time effects,processing and time interaction effects,and different times have statistical significance.Corneal endothelial cell density:There was no significant difference between the two groups before,1w,4w and 12w after operation.There was no significant difference in postoperative 1w,4w and 12w compared with preoperative.There was a significant difference between 12w after operation and preoperative in implantation group.There was no significant difference between 1w,4w after operation and before operation.Time effects,processing and time interaction effects,and different times have statistical significance.6A:There was no significant difference between the two groups before,1w,4w and 12w after operation.There was a significant difference between 1w,4w after operation and preoperative in resection group.There was no significant difference in postoperative 12w compared with preoperative.There was a significant difference between 1w,4w,12w after operation and preoperative in implantation group.Time effects,processing and time interaction effects had statistical difference,12w had no statistical difference.CV:There was no significant difference between the two groups before,1w,4w and 12w after operation.There was a significant difference between 1w,4w after operation and preoperative in resection group.There was no significant difference in postoperative 12w compared with preoperative.There was a significant difference between 1w,4w after operation and preoperative in implantation group.There was significant difference in postoperative 12w compared with preoperative.Time effects had statistical difference,processing and time interaction effects had no statistical difference.7.In the resection group,there was significantly regression of the new blood vessels on the surface of iris,and the pain gradually disappeared on the 1st to 2nd after surgery and the 3rd to7d after surgery.In the implanted group,the new blood vessels on the surface of iris significantly subsided.8.Complications:the incidence of complications was significantly different between the two groups(?2=5.483,P<0.05).Conclusion Anti-VEGF and panretinal photocoagulation combined with trabeculectomy and Ahmed drainage valve implantation can control the intraocular pressure of patients with neovascular glaucoma well,improve the vision,and achieve good clinical effect.Anti-VEGF and panretinal photocoagulation combined with trabeculectomy caused greater damage to corneal endothelial cells.The percentage of hexagonal cells decreased,the morphology of corneal endothelial cells changed,and the density of corneal endothelial cells decreased.However,anti-VEGF and total retinal photocoagulation combined with Ahmed drainage valve implantation caused less damage to the corneal endothelial cells,and the corneal endothelial cell structure recovered to the normal level after surgery.Anti-VEGF and total retinal photocoagulation combined with Ahmed drainage valve implantation is a safe,effective,simple and less invasive treatment for neovascular glaucoma.