Ahmed引流阀植入联合玻璃体腔注射Avastin治疗NVG

观察Ahmed阀植入联合玻璃体腔注射avastin治疗新生血管性青光眼(neovascular glaucoma, NVG)的疗效。 方法：对NVG患者20例20眼先行玻璃体腔注射avastin 0.1mL(2.5mg)，待虹膜新生血管消退后行Ahmed青光眼引流阀植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症，随访6～36(平均24)mo。 结果：玻璃体腔注射avastin后1wk内20眼虹膜新生血管均不同程度消退。Ahmed引流阀植入术后最后一次随访20眼中仅有3眼联合1～3种抗青光眼药物眼压≤21mmHg,1眼因眼压无法控制而行睫状体冷凝术（术后眼压控制），其余16眼无需加用抗青光眼药物眼压控制在正常范围。最后一次随访，平均眼压13.62±3.81mmHg，与术前平均眼压（44.17±16.17mmHg）比较，差异有统计学意义(t=11.028,P=0.000)。视力提高者8眼（40％），保持不变者12眼。全部病例在玻璃体腔注射avastin及Ahmed引流阀植入术中术后均未观察到严重手术并发症。 结论：Ahmed引流阀植入联合玻璃体腔注射avastin治疗NVG安全有效，手术成功率高，并发症少，有利于保护残留的视功能，但其长期疗效还需进一步观察，同时要注意原发病的处理。 关键词：新生血管性青光眼；Ahmed引流阀；玻璃体腔注射；avastin

Ahmed glaucoma valve implantation and intravitreal Avastin for neovascular glaucoma

AIM:To demonstrate the effect of Ahmed glaucoma valve implantation and intravitreal avastin in the treatment of neovascular glaucoma(NVG).METHODS:A retrospective random case series study was performed.Twenty eyes of twenty cases who presented with NVG were first treated with intravitreal bevacizumab 2.5 mg in 0.1 mL,then with Ahmed glaucoma valve implantation after regression of iris neovessels.Cases were followed up for 6-36(mean 24) months with observation on visual acuity,IOP control,regression of iris neovessels,and complications during or after surgery.RESULTS:All cases regressed iris neovessels at different degree within 1 week after injection.At final follow-up,the IOP of 16 eyes were all less than 21mmHg without any drugs and of 3 eyes with 1-3 kinds of anti-glaucoma drugs after combined Ahmed glaucoma valve implantation.The IOP of one eye was controlled after cryotherapy.The mean IOP dropped from 44.17±16.17mmHg preoperatively to 13.62±3.81mmHg postoperatively.IOP reduction was statistically different between preoperative and postoperative(t=11.028,P=0.000) at final follow-up.Visual acuity was improved in 8 cases(40%) and was no changed in 12 cases.No serious complications were observed during or after intravitreous injection and Ahmed glaucoma valve implantation.CONCLUSION:Ahmed glaucoma valve implantation and intravitreal avastin in the treatment of NVG is useful and safe.On one hand,it improves the success rate of surgery and preserves visual function,furthermore its complications are less.However,its chronic effect needs to further follow-up.At the same time,we should take some treatment to the protopathy of this disease.