Ahmed引流阀植入联合玻璃体腔注射Bevacizumab治疗NVG

Observation of curative effect of glaucoma valve implantation and intravitreal Bevacizumab for neovascular glaucoma

摘要:

目的：观察Ahmed引流阀植入联合玻璃体腔注射bevacizumab(贝伐珠单抗)治疗新生血管性青光眼(neovascular glaucoma，NVG)的疗效。

方法：对22例22眼新生血管性青光眼患者先进行玻璃体腔注射bevacizumab 0.1mL(2.5mg)，待虹膜新生血管消退后行Ahmed青光眼阀门植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症，随访6～36(平均24)mo。

结果：玻璃体腔注药后1wk内22眼虹膜新生血管均有不同程度消退，Ahmed引流阀植入术后随访22眼中仅有3眼联合使用1～3种抗青光眼药物，眼压控制在21mmHg之内，1眼因眼压失控而行睫状体光凝术(810激光)，其余18眼均无需加用抗青光眼药物眼压控制在正常范围内，最后一次随访，平均眼压15.59±3.21mmHg，与术前平均眼压(45.36±8.13mmHg)相比，差异有统计学意义(P<0.05)。视力提高者9眼(41%)，保持术前视力者13眼。全部病例在玻璃体腔注射bevacizumab及Ahmed引流阀植入术中术后均未观察到严重手术并发症。

结论：Ahmed引流阀植入联合玻璃体腔注射bevacizumab治疗NVG安全有效，手术成功率高，并发症少，有利于保护残留视功能。

Abstract:

AIM: To observe the effect of Ahmed glaucoma valve implantation intravitreal bevacizumab in the treatment of neovascular glaucoma(NVG).

METHODS: Twenty-two cases(22 eyes)who presented with NVG were first treated with intravitreal bevacizumab 0.1mL(2.5mg), then with Ahmed glaucoma valve implantation after regression of iris neovessels. Cases were followed-up for 6-36(mean 24)mo with observation on visual acuity, IOP control, regression of iris neovessels, and complications during or after surgery.

RESULTS: Iris neovessels was regressed in different degree after injection within 1wk in 22 eyes. At final follow-up, the IOP of 18 eyes were all less than 21mmHg without any drugs and of 3 eyes with 1-3 kinds of anti-glaucoma drugs after combined Ahmed glaucoma valve implantation. The IOP of one eye was controlled after cryotherapy. The mean IOP dropped from 45.36±8.13mmHg preoperatively to 15.59±3.21mmHg postoperatively. IOP reduction was statistically significance between preoperative and postoperative(P<0.05)at final follow-up. Visual acuity was improved in 9 eyes(41%)and was no changed in 13 eyes. No serious complications were observed during or after intravitreous bevacizumab injection and Ahmed glaucoma valve implantation.

CONCLUSION: Ahmed glaucoma valve implantation and intravitreal bevacizumab in the treatment of NVG is useful and safe. It improves the success rate of surgery and preserves visual function, furthermore its complications are less.