玻璃体腔注射贝伐单抗联合小梁切除术治疗新生血管性青光眼疗效研究  

Intravitreal bevacizumab and trabeculectomy in the treatment of neovascular glaucoma

作　　者：林朝斌[1] 吴晓民[1] 朱梅红[1] 林金泉[1] 庄国斌[1] 

机构地区：[1]福建医科大学附属泉州第一医院眼科,福建泉州362000

出　　处：《中国实用眼科杂志》2013年第10期1291-1294,共4页Chinese Journal of Practical Ophthalmology

基　　金：泉州市科技局重点项目（Z[2009]0147）

摘　　要：目的采用玻璃体腔注射贝伐单抗治疗新生血管性青光眼，评价其对虹膜新生血管（NVI）消退和眼压控制的作用。方法采用回顾性研究。对22例（22只眼）新生血管性青光眼（NVG），行玻璃体腔内注射贝伐单抗（IVB）2．5mg／0．1ml。对伴有虹膜前粘连的NVG患者，除了进行IVB，同时还进行复合式小梁切除术。进行上述操作后的患眼，都尽可能早地进行全视网膜光凝术（PRP）。所有患者随访12个月。随访内容包括：NVI消退程度、眼压控制情况、视力提高程度和滤过性手术成功与否。结果进行IVB后的第2个月，所有患眼的NVI消退；第4个月，6例（27．3％）再次出现NVI，而第8个月时16例（72．7％）NVI复发。平均IOP从（42．93±5．61）mmHg分别下降到（19．93±3．83）mmHg（第6个月）和（16．72±1．91）mmHg（第12个月）。复合式小梁切除术成功率达70％。19例（86．4％）患眼视力提高，分别从术前的（O．10±0．08）提高到术后的（0．15±0．12）。结论IVB治疗NVG患者，对NVI消退和眼压控制起到一定作用，同时提高复合式小梁切除术的成功率；但这一作用具有时间局限性，需要反复进行IVB以维持疗效。Objective To demonstrate the role of intravitreal bevacizumab in regression of iris neovascularization, and intraocular pressure （lOP） control in neovascular glaucoma. Methods A retro-spective random case series study was performed. Twenty-two eyes of 22 patients who presented with neovascular glaucoma were treated with intravitreal bevacizumab 2.5mg in 0.1ml. Subscleral tra-beculectomy was performed for cases having peripheral anterior synechiae. Panretinal photocoagula-tion （PRP） was carried out for all cases as soon as possible after intravitreal injection. Cases were followed up for 12 months when regression of iris neovessels, IOP control, improvement in visual acuity, and success of filtering surgery were recorded. Results All cases showed complete regres-sion of iris neovessels at 2 months after injection, recurrence of iris neovessels was observed in 6 cases （27.3%） at 4 months and in 16 cases （72.7%） at 8 months follow-up. The mean IOP dropped from （42.93 ± 5.61） mmHg preoperatively to （19.93±3.83） mmHg and （16.72±1.91） mmHg at 6 months and 12 months postoperatively, respectively. The success rate of subscleral trabeculectomy af-ter intravitreal bevacizumab was 70%. Visual acuity was improved in 19 cases （86.4%） from preoper-ative （0.10±0.09） to （0.16±0.12）postoperative. Conclusions Intravitreal bevacizumab has a role in regression of iris neovessels and IOP control in neovascular glaucoma cases and also in increasing the success rate of subscleral tra-beculectomy, however this role has a limited time and reinjection is needed to maintain this effect.

关 键 词：新生血管性青光眼 玻璃体腔注射贝伐单抗 小梁切除术 虹膜新生血管 眼压 

分 类 号：R775[医药卫生—眼科]