玻璃体腔注射Avastin联合小梁切除术治疗新生血管性青光眼

目的 探讨玻璃体腔注射Avastin联合复合式小梁切除术治疗新生血管性青光眼的疗效和安全性.方法 2008年1月至2010年1月收治的闭角期新生血管性青光眼24例24只眼,其中增殖性糖尿病视网膜病变9例9只眼,视网膜中央静脉阻塞8例8只眼,视网膜分支静脉阻塞2例2只眼,视网膜静脉周围炎2例2只眼,原发性闭角型青光眼绝对期2例2只眼,慢性葡萄膜炎1例1只眼.先行玻璃体腔注射Avastin,待虹膜新生血管消退或萎缩后,再行复合式小梁切除术.观察玻璃体腔内注射Avastin后虹膜及房角新生血管消退的时间、眼压的变化、并发症以及复合式小梁切除术后眼压、滤过泡的形态、术后反应.术后随访11～24个月,平均(16.25±0.82)个月.结果 注药后24只眼中22只眼虹膜新生血管2～7d完全消退,平均(4.29±1.98)d,2只眼注药后虹膜新生血管萎缩,保留少许残迹直至注药后2周.注药前眼压30.0～54.5mmHg,平均(40.83±6.29)mmHg,注药后1周眼压32.0358.0mmHg,平均(39.54±6.61)mmHg,注药前后眼压变化无统计学意义(t=1.879,P＞0.05).至复合式小梁切除术后最后一次随访24只眼中19只眼(79.17%)无需加用抗青光眼药物眼压≤21mmHg;4眼(16.67%)加用1-2种抗青光眼药物治疗眼压≤21mmHg;1只眼(4.16%)因眼压无法控制行睫状体光凝术后眼压控制.术后最后一次随访视力提高者有10只眼(41.67%),保持不变者有14只眼(58.33%).全部病例在玻璃体腔注射Avastin及复合式小梁切除术后均未观察到眼内炎、严重手术并发症.结论 玻璃体腔注射Avastin可使新生血管青光眼虹膜新生血管迅速消退或萎缩,再联合行复合式小梁切除术可避免术中术后出血,减轻术后炎症反应,显著提高手术成功率,有利于保护残留的视功能,但应注意原发病的治疗.同时应注意玻璃体腔注射Avastin可能带来的医疗风险.

Effect and safety of intravitreous injection of Avastin combined with trabeculectomy with mitonycin C (MMC) for neovascular glaucoma

Objective To evaluate the effect and safety in the treatment of neovascular glaucoma (NVG) by using intravitreous injection of Avastin combined with trabeculectomy with MMC. Methods Twenty-four eyes of 24 patients with angle-closure NVG were treated by intravitreous injection of Avastin combined with trabeculectomy with MMC after atrophy of iris neovascularization from January 2008 to January 2010. The regressions of iris neovascularization, changes of intraocular pressure, characters of filtering bleb and complications of intravitreous injection and surgery were observed in a 11-24 months follow-up period. Results Iris neovascularization was completely regressed during 2-7 days after injection in 22 eyes.However, a few new vessels ware still remnant in the other 2 eyes. There was no significant difference between before and after injection. The lOPS of 19 eyes were all less than 21mmHg in without any drugs and of 4 eyes with 1-2 kinds of anti-glaucoma drugs after combined trabeculectomy. The IOP of 1 eye was controlled after ciliary body photo-coagulation. Visual acuity was improved 1-2 lines in 10 eyes and was no change in 14 eyes.No serious complications were observed after intravitreous injection and trabeculectomy with MMC. Conclusions Intravitreous injection of Avastin could significantly induce the regression of iris neovascularization,avoid haemorrhage during combined trabeculectomy, relieve postoperative inflammation. It improves the successful rate oftrabeculectomy with MMC and remaines visual function. However, the treatment of the protopathy and potential medical treatment risk of intravitreal Avastin should be mentioned.