Abstract:

Objective　To investigate the curative effect of intravitreal injection of Ranibizumab combined with panretinal photocoagulation for neovascular glaucoma (NVG). Methods　A total of 90 patients with NVG admitted to Xianyang Central Hospital from June 2020 to June 2023 were selected as the study objects, all of whom were monocular lesions. The patients were divided into an observation group and a control group with 45 cases in each group by the random number table method. There were 28 males and 17 females in the observation group, aged 24-76 (50.62±4.01) years; the affected eye was right eye in 23 cases and left eye in 22 cases; the disease stages were stage Ⅱ in 25 cases and stage Ⅲ in 20 cases; the causes were retinal vein obstruction in 12 cases, diabetic retinopathy in 25 cases, and carotid artery stenosis of eye ischemia syndrome in 8 cases. There were 26 males and 19 females in the control group, aged 25-78 (51.24±4.32) years; the affected eye was right eye in 21 cases and left eye in 24 cases; the disease stages were stage Ⅱ in 23 cases and stage Ⅲ in 22 cases; the causes were retinal vein obstruction in 14 cases, diabetic retinopathy in 24 cases, and carotid artery stenosis of eye ischemia syndrome in 7 cases. The control group was treated with panretinal photocoagulation (a total of 4 times, interval of 2 d), and the observation group was treated with intravitreal injection of Ranibizumab 3 d before surgery on the basis. The clinical efficacy 1 week after surgery, intraocular pressure (IOP) and serum long non-coding RNA- lung adenocarcinoma metastasation-related transcription factor 1 (lncRNA MALAT1) levels before surgery and 1 week, 1 month, and 6 months after surgery, visual acuity improvement 6 months after surgery, and complications within 1 month after surgery were compared between the two groups. Repeated measure ANOVA, independent sample t test, paired t test, χ² test, and rank sum test were used for statistical analysis. Results　One week after surgery, the total treatment success rate of the observation group was higher than that of the control group [95.56% (43/45) vs. 77.78% (35/45)] (P<0.05). One week, one month, and six months after surgery, the IOP of the observation group was lower than that of the control group [(25.47±4.19) mmHg (1 mmHg=0.133 kPa) vs. (29.59±4.92) mmHg, (20.15±3.42) mmHg vs. (23.82±4.06) mmHg, (13.01±2.11) mmHg vs. (17.27±2.65) mmHg] (all P<0.05); the serum lncRNA MALAT1 level in the observation group was lower than that of the control group [(105.14±11.59) ng/L vs. (123.26±12.01) ng/L, (84.31±10.89) ng/L vs. (101.69±11.22) ng/L, (77.26±10.32) ng/L vs. (91.48±9.53) ng/L] (all P<0.05). Six months after surgery, the visual acuity improvement of the observation group was better than that of the control group (P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups within 1 month after surgery (P>0.05). Conclusion　Intravitreal injection of Ranibizumab combined with panretinal photocoagulation is effective in the treatment of NVG, which can improve the patients' IOP and visual acuity, reduce the serum lncRNA MALAT1 level, and has good safety.

Key words:

Glaucoma, Neovascular, Intravitreal injection of Ranibizumab, Panretinal photocoagulation, lncRNA MALAT1

摘要：

目的　探讨全视网膜光凝术联合玻璃体腔注射雷珠单抗治疗新生血管性青光眼（NVG）的效果。方法　选取2020年6月至2023年6月咸阳市中心医院收治的90例NVG患者作为研究对象，均为单眼病变。采用随机数字表法，将患者分为观察组和对照组，各45例。观察组男28例，女17例；年龄24～76（50.62±4.01）岁；患眼：右眼23例，左眼22例；疾病分期：Ⅱ期25例，Ⅲ期20例；病因：视网膜静脉阻塞12例，糖尿病视网膜病变25例，颈动脉狭窄眼缺血综合征8例。对照组男26例，女19例；年龄25～78（51.24±4.32）岁；患眼：右眼21例，左眼24例；疾病分期：Ⅱ期23例，Ⅲ期22例；病因：视网膜静脉阻塞14例，糖尿病视网膜病变24例，颈动脉狭窄眼缺血综合征7例。对照组采用全视网膜光凝术（分4次完成，间隔2 d），观察组在对照组基础上联合玻璃体腔注射雷珠单抗（术前3 d注射1次）。比较两组术后1周临床疗效，术前和术后1周、1个月、6个月眼压和血清长链非编码RNA-肺腺癌转移相关转录因子1（lncRNA MALAT1）水平，术后6个月视力改善情况，术后1个月内并发症发生情况。采用重复测量方差分析、独立样本t检验、配对t检验、χ²检验和秩和检验进行统计学分析。结果　术后1周，观察组治疗总成功率高于对照组［95.56%（43/45）比77.78%（35/45）］（P<0.05）。术后1周、1个月、6个月，观察组眼压均低于对照组［（25.47±4.19）mmHg（1 mmHg=0.133kPa）比（29.59±4.92）mmHg、（20.15±3.42）mmHg比（23.82±4.06）mmHg、（13.01±2.11）mmHg比（17.27±2.65）mmHg］（均P<0.05）；观察组血清lncRNA MALAT1水平均低于对照组［（105.14±11.59）ng/L比（123.26±12.01）ng/L、（84.31±10.89）ng/L比（101.69±11.22）ng/L、（77.26±10.32）ng/L比（91.48±9.53）ng/L］（均P<0.05）。术后6个月，观察组视力改善情况优于对照组（P<0.05）。术后1个月内，两组术后并发症总发生率比较，差异无统计学意义（P>0.05）。结论　全视网膜光凝术联合玻璃体腔注射雷珠单抗治疗NVG效果较好，可改善患者眼压和视力情况，降低血清lncRNA MALAT1水平，安全性较好。

关键词:

青光眼, 新生血管性, 玻璃体腔注射雷珠单抗, 全视网膜光凝术, lncRNA MALAT1