Bevacizumab辅助手术治疗新生血管性青光眼临床观察

The assistant effectiveness ofintravitreal injection of Bevacizumab to anti-glaucoma operation in the treatment ofneovascular glaucoma

目的观察玻璃体腔注射Bevacizumab，小梁切除联合玻璃体切除治疗新生血管性青光眼临床疗效。方法对19例19只眼药物不能控制的新生血管性青光眼患者，应用角膜缘后4mm玻璃体腔注射Bevacizumab0.05ml／1．25mg，治疗后7d进行小梁联合玻璃体切除。结果平均随访6月。19只眼视力保持稳定或稍有增进。接受注药后3d虹膜表面、房角新生血管消失11只眼，5～7d完全消失8只眼。角膜水肿5只眼消失，14只眼较前减轻。Bevacizumab注射前平均眼压56．00mmHg，注射后7d平均眼压41．52-mmHg，显著低于注射前水平（P〈0.001）.小梁切除联合玻璃体切除术后7d，14d，1月，3月，6月平均眼压分别为13．32mmHg，15．63mmHg，19．26mmHg，19．53mmHg和19．74mmHg，均显著低于注射后7d水平（P〈0．001）.术后眼压控制完全成功16只眼，部分成功2只眼。眼压未控制1只眼。所有患者眼痛、头痛症状缓解。结论Bevacizuma玻璃体腔注射在新生血管性青光眼手术治疗过程中有积极的辅助作用，能够减少术中术后治疗过程中眼内出血的风险，为手术治疗新生血管性青光眼创建一个良好的平台。

Objective To investigate the effectiveness of anti-glaucoma operation combining with intravitreal injection of Bevacizumab in the treatment of neovascular glaucoma. Methods In this study 19 cases of neovascular glaucoma patients received trabeculectomy and vitrectomy, seven days after intravitreal injection of 0.05ml/1.25ing Bevacizumab. Examination included measurement of neovascular on iris and angle of anterior chamber,intraocular pressure. Results The average follow-up period is 6mon. visual acuity of all 19 cases had kept stable or increased slightly. Three days post injection,the neovascular on iris and angle of anterior chamber had disappeared throughly in 11 eyes,which number had increased to 19 until 5-7 days postinjection. The mean lOP achieved was 41.52 mmHg,7days after injection and they were significantly different from preinjection,which was 56.00 mmHg （P 〈0.001 ）. The mean lOP achieved was 13.32 mmHg, 15.63 mmHg,19.23 mmHg, 19.53 mmHg and 19.74 mmHg in 7,14 days and 1,3 and 6 months after trabeculectomy and vitrectomy, respectively, and they were significantly different from preinjection, which was 56.00 mmHg （P〈 0.001 ）. There were 16 cases of eyes.Conclusion Intravitreal injection of Bevacizumab was an very effective assistant method of anti-glaucoma operation in the treatment of neovascular glaucoma , which could reduce the risk ofintraocular hemorrhage during anti-glaucoma operation and made it possible and safely to perform the trabeculectomy and vitrectomy in the treatment of neovascular glaucoma.