目的:观察玻璃体腔注射bevacizumab(intravitreal bevacizumab,IVB),联合玻璃体切除、视网膜光凝+小梁切除术治疗新生血管性青光眼(neovascular glaucoma,NVG)临床疗效。方法:对2007-06/2009-06在我院眼科收治由于视网膜中央静脉阻塞(缺血型)继发新生血管性青光眼患者27例27眼,角膜缘后3.5mm玻璃体腔注射bevacizumab0.05mL/1.25mg,治疗后7d进行玻璃体切除、视网膜光凝+小梁切除。术后随访12mo,观察视力、虹膜及房角新生血管及眼压情况。结果:IVB 7d后,25眼虹膜表面、房角新生血管消失(93%)。2眼新生血管明显变细,但未完全消退(7%)。IVB治疗前平均眼压(55.81±4.65)mmHg,治疗后7d平均眼压(42.07±7.49)mmHg,两者眼压比较虽然差异有显著性(t=14.973,P<0.01),但局部应用降眼压药后眼压仍高于正常范围(28～50)mmHg。玻璃体切除、视网膜光凝+小梁切除术后1,3,6,9,12mo,平均眼压分别为(14.85±4.56;16.70±3.73;20.04±6.58;19.30±4.74;19.67±4.12)mmHg,与IVB后7d平均眼压比较差异均有显著性(P<0.01)。手术后眼压控制完全成功22眼(82%),部分成功3眼(11%),眼压未控制2眼(7%)。27眼视力均保持稳定或稍有增进。结论:IVB辅助手术治疗NVG,可以促进虹膜、房角、视网膜新生血管迅速消退,有效的控制眼压,降低手术并发症,提高了手术的成功率,同时进行原发病的治疗远期效果明显提高。

AIM:To observe the clinical effect of the intravitreal bevacizumab(IVB) combined with vitrectomy,retinal photocoagulation and trabeculectomy as a mult-treatment for the neovascular glaucoma(NVG). METHODS:Totally 27 patients 27 eyes which had the NVG secondary from central retinal vein occlusion(CRVO) were enrolled.All eyes accepted the vitrectomy,retinal photocoagulation combined with trabeculectomy 7 days after IVB(0.05mL/1.25mg).The visual acuity,the condition of the new vessels on the iris and the angle of anterior chamber and the intraocular pressure(IOP) were observed 12 months postoperatively. RESULTS:The new vessels on the iris and the angle of anterior chamber regressed completely in 25 eyes(93%), 7 days after IVB and thinned obviously in 2 eyes but not regressed(7%).The mean IOP before the IVB(55.81±4. 65mmHg) and the after(42.07±7.49mmHg) had significant difference(t = 14.973,P<0.01),but still higher than normal level(28-50mmHg).The mean IOP 1 month,3,6, 9 and 12 months after the vitrectomy,retinal photocoagulation and trabeculectomy(14.85±4.56,16.70±3.73,20. 04±6.58,19.30±4.74,19.67±4.12,respectively) mmHg and 7 days after IVB had significant difference(P<0.01). The IOP were controlled completely in 22 eyes(82%), partly controlled in 3 eyes(11%),and not controlled in 2 eyes(7%).The visual acuity of all the eyes was stable and rise slightly. CONCIUSION:IVB as an adjunct method combined with vitrectomy,retinal photocoagulation and trabeculectomy can make the new vessels on the iris and the angle of anterior chamber regression and to lower the IOP,thus it can increase the achievement ratio of the operation and decrease the complication.And the long-term effect is better to cure the protopathy at the same time.

R779.6

中国陕西省科技攻关基金资助项目(No.2008K01-40)~~