玻璃体腔Bevacizumab注射后联合二联术治疗新生血管性青光眼

Intravitreal Bevacizumab injection combined duplex technique in treatment of neovascular glaucoma

摘要:

目的：观察玻璃体腔bevacizumab注射后联合二联术治疗新生血管性青光眼(neovascular glaucoma，NVG)的临床疗效。

方法：NVG患者25例25眼，行玻璃体腔内注射bevacizumab 1.0mg(0.05mL)，待虹膜新生血管消退，其中5眼行前房穿刺放液辅助控制眼压，2wk后均接受小梁切除+白内障超声乳化术(有9眼植入人工晶状体)。术后观察患者的眼压、视力、角膜、新生血管的变化及并发症，并随访12mo。

结果：患者25眼注射bevacizumab后，有20眼于3～5d虹膜新生血管消退，另有5眼于7d后虹膜新血管消退，控制眼压后，测角膜内皮细胞计数1 629±226个/mm²，小梁切除+白内障超声乳化术后均未发生角膜内皮失代偿； 随访12mo，20眼眼压控制在正常范围，2眼用1种抗青光眼药后眼压可控制在正常范围，3眼用抗青光眼药后眼压34～38mmHg。9眼植入人工晶状体后，视力有提高。

结论：玻璃体腔注射bevacizumab可以短期有效清除虹膜和前房角新生血管，降低眼压，并减少术中、术后出血风险，联合小梁切除+白内障超声乳化术可有效治疗新生血管性青光眼。

Abstract:

AIM: To observe the clinical curative effect of intravitreal Bevacizumab injection combined duplex technique in treatment of neovascular glaucoma(NVG).

METHODS:Totally 25 eyes of 25 patients with NVG who underwent intravitreal Bevacizumab injection of 1.0mg(0.05mL), after the regression of iris neovascularization, 5 eyes with anterior chamber paracentesis fluid auxiliary controlled intraocular pressure. After 2wk, patients were treated by trabeculectomy and phacomulsification(9 eyes were implanted intraocular lens). The changes and complications of intraocular pressure, visual acuity, corneas and neovessels were observed after surgery, and followed up 12mo.

RESULTS:After injection Bevacizumab in 25 eyes, iris neovascularization of 20 eyes subsided in 3～5d, and 5 eyes subsided in 7d. After controlling intraocular pressure, count of the corneal endothelial cell were 1 629±226mm², and none suffered decompensation of corneal endothelium after two-surgery of trabeculectomy and phacomulsification. After followed up 12mo, intraocular pressure of 20 eyes were controlled in normal range; 2 eyes could control in normal range after treated by a kind of anti-glaucoma medicine and 3 eyes was 34～38mmHg after treated by anti-glaucoma medicine. 9 eyes had improved vision after implanted intraocular lens.

CONCLUSION:Intravitreal Bevacizumab injection can subside iris and anterior chamber angle neovascularization effectively in a short time and reduce intraocular pressure. It can also reduce the risk of bleeding during operation or after operation. Intravitreal Bevacizumab injection combined with two-surgery of trabeculectomy and phacomulsification can treat neovascular glaucoma effectively.