Bevacizumab在新生血管性青光眼治疗中的应用

新生血管性青光眼(neovascular glaucoma,NVG)常继发于眼内多种缺血、缺氧性疾病,其发病机理主要是由于缺血、缺氧性视网膜病变引起的血管内皮生长因子(vascular endothelial growth factor,VEGF)基因高表达.从而引起房水中VEGF含量增加,刺激虹膜及房角新生血管形成而发病.局部降眼压药物治疗效果不佳,手术治疗容易出现术中出血、术后局部炎症反应重、滤过泡瘢痕化等并发症,因此属于难治性青光眼.近年来,随着VEGF抗体Bevacizumab在眼科的应用,将NVG治疗引入了新的领域.本文就Bevacizumab在NVG治疗中的应用作一简要综述.     

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。     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

贝伐单抗治疗新生血管性青光眼的研究进展

贝伐单抗(bevacizumab)是一种新型的抗血管内皮生长因子人源化单克隆抗体,能有效地减少新生血管的活动性,降低新生血管的渗透性,促进虹膜和房角新生血管消退,有效地控制眼压.玻璃体腔注射贝伐单抗可单独或联合手术治疗新生血管性青光眼,为治疗新生血管性青光眼开辟了新的道路.本文就贝伐单抗治疗新生血管性青光眼的进展进行综述.     

Bevacizumab in glaucoma: a review

Recent research has shown that a large number of growth factors are responsible for neovascularization. Vascular endothelial growth factor has been identified as playing a key role in ocular angiogenesis. Bevacizumab, a humanized monoclonal antibody that binds to all isoforms of vascular endothelial growth factor, has shown promising results in regression of neovascularization. The use of bevacizumab has been reported extensively in various retinal pathologies, including proliferative diabetic retinopathy, cystoid macular edema, neovascular age-related macular degeneration, and neovascular glaucoma, but the clinical use in glaucoma is not yet clear. Glaucoma filtering surgery entails fashioning an external filter for aqueous drainage, and a prerequisite to its optimum functioning is a patent filtering bleb. Since fibroblast function and growth of new vessels is a component of healing of the bleb, there have been attempts to retard this healing by the use of bevacizumab. This article reviews current clinical studies documenting the use of bevacizumab in glaucoma.     

Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab

To describe three cases of neovascular glaucoma (NVG) where iris or angle neovascularization regressed remarkably after subconjunctival bevacizumab injections used as the initial treatment before pan retinal photocoagulation (PRP) and/or filtering surgery. Three consecutive NVG patients whose intraocular pressure (IOP) was not controlled with maximal medication were offered an off-label subconjunctival injection of bevacizumab (2.5-3.75 mg/0.1-0.15 mL, Avastin). Bevacizumab was injected into the subconjunctival space close to the corneal limbus in two or three quadrants using a 26-gauge needle. Serial anterior segment photographs were taken before and after the injection. Following subconjunctival injection of bevacizumab, iris or angle neovascularization regressed rapidly within several days. Such regression was accompanied by lowering of IOP in all three cases. The patients underwent subsequent PRP and/or filtering surgery, and the IOP was further stabilized. Our cases demonstrate that subconjunctival bevacizumab injection can be potentially useful as an initial treatment in NVG patients before laser or surgical treatment.     

Intravitreal bevacizumab in a patient with neovascular glaucoma.

The utility of intravitreal bevacizumab injection in a patient with neovascular glaucoma following central retinal vein occlusion is explored. Bevacizumab (1 mg in 0.04 mL) was used after failed intraocular pressure (IOP) control with transscleral cyclophotocoagulation and panretinal photocoagulation. IOP improved within 2 days and the patient experienced marked improvement in comfort. Bevacizumab may be an effective medication for the treatment of neovascular glaucoma.     

Antiangiogene Therapie bei neovaskulärem Glaukom und nach Filterkissenchirurgie

Bevacizumab is increasingly discussed as adjuvant treatment for rubeosis and for all stages of neovascular glaucoma. In incipient rubeosis bevacizumab has a preventive effect and arrests the progression of disease. In the case of increasing involvement of the anterior chamber angle, bevacizumab should be integrated into stage-adapted treatment to achieve successful control of intraocular pressure. The treatment of the causative ischemic stimulus is necessary in every stage of disease. One further indication for bevacizumab is the postoperative inhibition of angiogenesis after glaucoma surgery. Possible routes of administration are subconjunctival application during trabeculectomy, postoperative needling, or intravitreal injection during a filtrating operation. This review summarizes results of current studies about bevacizumab for rubeosis, neovascular glaucoma, or filtrating surgery and adds future perspectives for possible therapeutic schemes.     

Adverse events associated with intraocular injections of bevacizumab in eyes with neovascular glaucoma

Background  

Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been reported to cause rapid regression of anterior segment neovascularization in eyes with neovascular glaucoma when administered intraocularly. Several studies have reported the safety profile of intravitreal injections of bevacizumab in patients with various retinal pathologies. We investigated the occurrence of adverse events associated with intraocular bevacizumab injections in patients with neovascular glaucoma.     

Rapid improvement of retinal and iris neovascularization after a single intravitreal bevacizumab injection in a patient with central retinal vein occlusion and neovascular glaucoma

Background Intravitreal injections of bevacizumab have been reported to have anatomical and functional success in treating choroidal neovascularization, macular edema and neovascular glaucoma. We report a case with neovascular glaucoma due to central retinal vein occlusion who demonstrates rapid resolution of anterior and posterior segment neovascularization after a single intravitreal bevacizumab injection. Case A 46-year old man with a 6-month history of central retinal vein occlusion presented with neovascular glaucoma. Fluorescein angiography revealed marked leakage from new vessels on the iris, disc and retina. Bevacizumab was used after incomplete panretinal photocoagulation because of inadequate fundus visualization. About a week after intravitreal bevacizumab injection, new vessels were no longer visible. IOP improved and additional laser photocoagulation was performed. Conclusion Intravitreal bevacizumab injection may be a useful alternative or adjuvant treatment for patients with neovascular glaucoma in whom inadequate visualization precludes adequate panretinal photocoagulation.     

Needle bleb revision of encapsulated filtering bleb with bevacizumab.

The utility of needle bleb revision with bevacizumab in a patient with a failing bleb following trabeculectomy is explored. The patient had previously failed needle bleb revision with mitomycin C. After needling and injection of 1 mg of bevacizumab, the bleb was noted to be more diffuse with a decrease in surface neovascularization. Bevacizumab may be an effective medication for rescuing failing filtering blebs that exhibit neovascularization.     

贝伐单抗在青光眼滤过性手术应用的研究进展

滤过泡瘢痕化是导致青光眼滤过性手术失败的主要因素,目前研究已证实血管内皮生长因子（vascularendothelialgrowthfactor,VEGF）在促进血管生成、创伤愈合、瘢痕形成中起重要作用。近年来眼科学者将VEGF抑制剂贝伐单抗（bevacizumab）作为抗瘢痕形成辅助用药用于青光眼滤过性手术,证实其对促进功能性滤过泡形成、控制眼压有较好的疗效,从而提高了手术成功率。本文就贝伐单抗在青光眼滤过性手术中的基础研究和临床应用等方面的研究进展作一综述。（国际眼科纵览,2012,36：298—301）     

Intravitreal bevacizumab for neovascular glaucoma following central retinal artery occlusion

PURPOSE: To report a case of neovascular glaucoma due to central retinal artery occlusion treated with a single intravitreal injection of bevacizumab. METHODS: A 68-year-old patient with a 10-week history of central retinal artery occlusion presented with neovascularization of the iris and the angle and intraocular pressure of 30 mm Hg. The patient received a single injection of 1.25 mg bevacizumab in 0.1 mL intravitreally. RESULTS: Iris and angle neovascularization regressed within 48 hours of the injection. Intraocular pressure dropped from 30 to 15 mm Hg, and there was marked improvement in patient comfort. Panretinal photocoagulation was applied 4 weeks after the injection. CONCLUSIONS: Bevacizumab seems to be a useful adjunct to panretinal photocoagulation in the treatment of neovascular glaucoma.