玻璃体腔注射Avastin治疗新生血管性青光眼

Intravitreal Avastin injection for the treatment of neovascular glaucoma

摘要:

目的：评价玻璃体腔注射Avastin治疗新生血管性青光眼的临床疗效。 方法：我院自2007-01/2011-10收治的视力>指数的新生血管性青光眼23例23眼，玻璃体腔注射Avastin后，观察虹膜新生血管的变化，3~7d新生血管消退，再行抗青光眼手术，术后观察患者的眼压、视力、新生血管的变化、眼部的炎症反应、并发症，并随访12~24mo。 结果：注射后，23眼中21眼于3~5d虹膜新生血管消退，有效率91.30%；2眼于5d变细，7d萎缩，至2wk时消退。注射前后眼压差值<2mmHg。23眼注射后均未出现并发症和不良反应，随后行复合小梁切除术。术后随访12~24mo，23眼中18眼无需加用抗青光眼药物，眼压位于正常范围；3眼加用2种抗青光眼药物，眼压<21mmHg；2眼加用3种抗青光眼药物，眼压<21mmHg。 结论：玻璃体腔注射Avastin可使新生血管性青光眼的新生血管迅速消退或萎缩，再行滤过性手术，避免术中或术后出血，无需选择破坏性手术，保留了较好的视力，且控制了眼压。术后进一步治疗并发症，保护残留的视功能。

Abstract:

AIM:To evaluate the clinical curative effect of intravitreal Avastin injection for the treatment of neovascular glaucoma. METHODS:There were 23 neovascular glaucoma patients(23 eyes) whose visual acuity was higher than counting fingers treated in our hospital from January 2007 to October 2011. After intravitreal Avastin injection, the change of iris neovessels was observed. When the neovessels subsided in 3-7 days, the anti-glaucoma operation was performed. The intraocular pressure, visual acuity, change of neovessels, inflammatory reaction, complications were observed and followed up 12-24months. RESULTS:In the 23 eyes, there were 21 eyes that iris neovessels subsided in 3-5 days after injection, the effective rate was 91.30%. There were 2 eyes that iris neovessels thinned in 5 days, atrophied in 7 days, and subsided in 2 weeks. The difference of intraocular pressure was less than 2mmHg before and after the Avastin injection. There were no complications and adverse reaction after Avastin injected in 23 eyes, then performed compound trabeculectomy. In the following up days of 12-24 months, there were 18 eyes intraocular pressure in normal range without anti-glaucoma medicine; there were 3 eyes intraocular pressure below 21mmHg adding 2 kinds of anti-glaucoma medicine and 2 eyes intraocular pressure below 21mmHg adding 3 kinds of anti-glaucoma medicine. CONCLUSION:Intravitreal Avastin injection can subside or atrophy the neovessels of neovascular glaucoma, then filtered operation were performed on patients, which avoids intra- or postoperative hemorrhage, destructive operation and preserves better visual acuity and controls intraocular pressure. The complications were treated postoperatively and visual function was protected.