Bevacizumab联合Ex-press引流管治疗新生血管性青光眼

Effect and safety of intravitreous injection of bevacizumab combined with Ex-press miniature glaucoma device implant for neovascular glaucoma

摘要:

目的：探讨玻璃体腔注射贝伐单抗(bevacizumab)联合Ex-press青光眼引流管植入术治疗新生血管性青光眼的疗效和安全性。

方法：对18例19眼新生血管性青光眼患者，先行玻璃体腔注射bevacizumab，待虹膜新生血管消退或萎缩后，再行Ex-press青光眼引流管(P-200)植入术，其中6例6眼联合超声乳化白内障吸除术。根据患者屈光介质情况术前或术后尽量行全视网膜光凝。Ex-press植入术后随访12mo，观察视力、眼压和手术并发症情况。

结果：玻璃体腔注药后2～7d，16眼新生血管全部消退。术后平均眼压：1mo：13.05±2.46mmHg，3mo：13.80±1.88mmHg，6mo：14.30±1.38mmHg； 12mo：14.60±1.43mmHg，术后1，3，6，12mo眼压与术前相比均有显著性差异(P<0.05)，且术后1，3，6，12mo眼压相比均无显著性差异(P>0.05)。19眼术后视力有提高者4眼，无明显改变15眼，无视力下降眼，完全成功11眼(58%)，部分成功5眼(26%)，总手术成功率84%(16/19)。术后并发症：有2例术后早期短暂浅前房，散瞳1wk后前房恢复正常，1例前房少量积血，无排斥反应和严重并发症。

结论：玻璃体腔注射bevacizumab可使新生血管青光眼虹膜新生血管迅速消退或萎缩，为下一步青光眼手术创造良好的条件。Ex-press青光眼引流管植入术是新的滤过性手术，该手术创伤小，不用切除虹膜，减少了术中、术后出血的风险，联合bevacizumab是治疗新生血管性青光眼的安全而有效的术式。

Abstract:

AIM: To evaluate the effect and safety in the treatment of neovascular glaucoma(NVG)by using intravitreous injection of bevacizumab combined with Ex-press miniature glaucoma device implant with MMC.

METHODS: Nineteen eyes of 18 patients with angle-closure NVG were treated by intravitreous injection of bevacizumab combined with Ex-press miniature glaucoma device implant with MMC after atrophy of iris neovascularization. The regressions of iris neovascularization, changes of intraocular pressure, characters of filtering bleb and complications of intravitreous injection and surgery were observed in a 12 months follow-up period.

RESULTS: Iris neovascularization was completely regressed during 2-7d after injection in 16 eyes. There was no significant difference between before and after injection. The IOPs of 11 eyes were less than 21mmHg without any drugs and of 5 eyes with 1-2 kinds of anti-glaucoma drugs after combined Ex-press implant. No serious complications were observed after intravitreous injection and ex-press implant with MMC.

CONCLUSION: Intravitreous injection of bevacizumab could significantly reduce the regression of iris neovascularization, avoid haemorrhage during subsequently Ex-press implanting, relieve postoperative inflammation. It improves the successful rate of Ex-press implant with MMC and remains visual function. However, the treatment of the protopathy and potential medical treatment risk of intravitreal bevacizumab should be mentioned.