Bevacizumab联合视网膜光凝治疗虹膜和视网膜新生血管

目的:观察Bevacizumab玻璃体腔注射联合视网膜光凝治疗虹膜和视网膜新生血管的疗效和安全性。方法:回顾分析虹膜和视网膜新生血管患者13例13眼玻璃体腔注射Bevacizumab联合视网膜光凝治疗的临床随访资料。13眼中视网膜新生血管9眼(其中继发于视网膜分支静脉阻塞的2眼,增生型糖尿病视网膜病变的6眼,Eales病的1眼),虹膜新生血管4眼(均继发于视网膜中央静脉阻塞)。13眼全部行玻璃体腔注射1.25mg/0.05mL的Bevacizumab,术前或术后分次补充完成视网膜光凝。随诊3～18mo,随访期间发现新生血管复发者,再行同样方法的注射和光凝治疗。观察治疗前后最佳矫正视力、眼压、眼底荧光血管造影。结果:经治疗后,13眼中8眼(61.5%)视力提高,4眼(30.8%)视力保持不变,1眼(7.7%)视力下降;6例合并玻璃体积血,术后均明显吸收;13眼视网膜及虹膜新生血管均消退,随诊期间复发2眼,行第二次注射和光凝治疗后新生血管无复发。虹膜新生血管(新生血管性青光眼)4眼中2眼治疗后眼压下降,随访期间均控制正常,另2眼联合青光眼阀植入后眼压控制正常。随诊期中,其余9眼眼压无升高。1例患者注药后结膜下出血,其余患者未出现其他并发症。结论:Bevacizumab玻璃体腔注射联合视网膜光凝治疗虹膜和视网膜新生血管在短期内能促进玻璃体积血吸收和新生血管萎缩,副作用少;但尚需进一步大样本、多中心的临床随机对照研究。

Research on intravitreal Bevacizumab combined with retinal photocoagulation for iris and retinal neovascularization

·AIM:To evaluate the efficacy and safety of intravitreal Bevacizumab(IVB)combined with retinal photoco-agulation for iris and retinal neovascularization.METHODS:The clinical data of 13 patients 13 eyes with iris or retinal neovascularization treated with IVB associated with retinal photocoagulation were retrospectively analyzed.Among these patients,retinal neovascularization was secondary to branch retinal vein occlusion(BRVO)in 2 eyes,to proliferative diabetic retinopathy(PDR)in 6 eyes and to Eales disease in 1 eye.4 eyes with iris and retinal neovascularization were secondary to central retinal vein occlusion.All of patients underwent IVB(1.25mg/0.05mL)combined with retinal photocoagulation.The follow-up period ranged from 3 to 18 months.Additional IVB and retinal photocoagulation were administered if recurrence was observed in follow-up period.The changes of best-corrected visual acuity(BCVA),intraocular pressure(IOP),fundus fluorescein angiography(FFA)were observed and analyzed before and after the treatment.RESULTS:At the end of the follow-up period,BCVA was improved obviously(>1 lines)in 8 eyes(61.5%),kept stable(changed within 1 line)in 4 eyes(30.8%)and decreased(>1 lines)in one eye(7.7%).The regression of iris and retinal neovascularization in all 13 eyes were observed by FFA image.There were 2 eyes with additional IVB and retinal photocoagulation during follow-up period.Among neovascular glaucoma,decreased IOP was noticed in 2 eyes(50.0%).The only complication was subconjunctival hemorrhage in one eye.CONCLUSION:The preliminary result in our observation shows that IVB combined with retinal photocoagulation is effective and safe in treating iris and retinal neovascularization.This should be comfirmed by a multicenter,randomized,controlled clinical trial.