目的：探讨神经生长因子(nerve growth factor，NGF)联合甲钴胺对青光眼术后视神经的保护作用及对基质金属蛋白酶-2(matrix metalloproteinase-2，MMP-2)、金属蛋白酶组织抑制因子-2(tissue inhibitor of matrix metalloprotease-2，TIMP-2)的影响。

方法：选取行小梁切除术治疗的急性闭角型青光眼患者54例73眼。按照数字列表法随机分为对照组(30例35眼)与联合组(24例38眼)。对照组术后应用甲钴胺治疗，联合组术后应用NGF和甲钴胺联合治疗。观察两组患者术后用药前后视力、眼压、平均视敏度(mean light sensitivity，MS)、平均缺损(mean visual field defect，MD)、视神经纤维层(retinal nerve fibre layer，RNFL)厚度、视乳头杯/盘比、P100波潜伏期、P100波振幅、神经特异性烯醇化酶(neuron-specific enolase，NSE)、一氧化氮(nitric oxide， NO)、一氧化氮合酶(nitric oxide synthase，NOS)活性、MMP-2和 TIMP-2的情况。监测用药期间不良反应。

结果：与用药前比较，两组患者用药后视力、MS、P100波振幅明显提高，MD、P100波潜伏期明显下降，差异有统计学意义(P<0.05)，但联合组的变化幅度明显大于对照组，差异有统计学意义(P<0.05)。两组患者用药前后眼压、RNFL、视乳头杯/盘比无明显变化，差异无统计学意义(P>0.05)。两组患者用药后NO、NOS、MMP-2水平升高，NSE、TIMP-2、TIMP-2/MMP-2下降，差异有统计学意义(P<0.05)，但联合组的变化程度大于对照组，差异有统计学意义(P<0.05)。

结论：NGF联合甲钴胺能有效改善青光眼术后视功能，对MMP-2、TIMP-2有一定的调节作用。

METHODS: Totally 54 patients(73 eyes)with acute angle closure glaucoma undergoing trabeculectomy was included in the study, and the patients were divided into the control group(30 cases, 35 eyes)and combination group(24 cases, 38 eyes)according to the digital table method. The patients in the control group were treated with mecobalamine, and the patients in combination group were treated with NGF combined with mecobalamine. Visual acuity, intraocular pressure, mean light sensitivity(MS), visual field mean defect(MD), retinal nerve fibre layer(RNFL)thickness, the nipple cup/disc ratio, P100 wave incubation period and amplitude of P100 wave, neuron-specific enolase(NSE), nitric oxide(NO), nitric oxide synthase(NOS), matrix metalloproteinase-2(MMP-2), metalloproteinases tissue inhibiting factor-2(TIMP-2)before and after treatment were observed in the two groups. The adverse reactions during medication were supervised.

RESULTS: Compared with those before treatment, visual acuity, MS, and P100 wave amplitudes increased, MD and P100 wave latency decreased(P<0.05)after treatment, the change ranges in combination group were greater than those in control group(P<0.05). There was no significant change in intraocular pressure, RNFL, the nipple cup/disc ratio before and after treatment in the two groups(P>0.05). Compared with those before treatment, serum NO, NOS, MMP-2 levels in the two groups increased, and the levels of NES, TIMP-2, TIMP-2/MMP-2 decreased(P<0.05), but the change degrees in combination group were greater than those in control group(P<0.05).

CONCLUSION: NGF combined with mecobalamine can improve postoperative visual function of glaucoma, which has certain regulatory effects on MMP-2 and TIMP-2.