雷珠单抗治疗视网膜中央静脉阻塞引起的眼前段新生血管

Effects of intravitreal injection of Lucentis for anterior segment neovascularization indeced by central retinal vein occlusion

目的：探讨雷珠单抗治疗视网膜中央静脉阻塞（central retinal vein occlusion,CRVO）引起的眼前段新生血管（anterior segment neovascularization,ASNV）的疗效。方法：回顾性研究,选取2013-01/2014-12我院门诊及住院的因CRVO引起的ASNV并经过雷珠单抗玻璃体腔注射治疗的连续病例18例18眼。观察患者的最佳矫正视力、眼压、虹膜情况、房角镜检查等,随访时间6~13（平均9.1±2.9）mo。结果：患者18例18眼都接受了雷珠单抗治疗,15例15眼行视网膜光凝,3例3眼因玻璃体混浊仅行抗VEGF治疗,1例1眼行青光眼阀植入。其中6例6眼为仅有虹膜新生血管而没有眼压升高的患者,这6例6眼患者经过雷珠单抗联合全视网膜光凝（panretinal photocoagulation,PRP）后视力提高,眼压控制。已经伴有新生血管性青光眼的患者中,经过雷珠单抗及PRP治疗后,眼压可以控制者4例4眼;另有7例7眼眼压在雷珠单抗治疗后可以降低,但仍需药物控制;1例1眼药物控制不良者植入青光眼阀治疗,术后眼压控制,但视力较注射雷珠单抗前变差。所有患者的虹膜新生血管均可以消退。结论：雷珠单抗可以有效地使虹膜新生血管消退并对眼压控制有所帮助,在早期没有眼压升高的时候效果更好,提示要早期发现虹膜血管并尽早干预。

AIM： To investigate the therapeutic effect of Lucentis in the treatm ent of anterior segm ent neovascularization（ ASNV） induced by central retinal vein occlusion（ CRVO）.METHODS： This was a retrospective case series study for patients with ASNV secondary to CRVO from January2013 to Decem ber 2014 and treated with intravitreal injection of lucentis. Best visual acuity（ BCVA）,intraocular pressure（ IOP）, iris exam ination and gonioscopy,and if necessary, fluorescein angiography and optical coherence tom ography,were recorded. The follow-up tim e was 6-13 m o, the average was 9. 1 ±2. 9m o.RESULTS： Eighteen patients（ 18 eyes） were treated with intravitreal injection of lucentis; 15 patients（ 15 eyes）of the 18 were treated with panretinal photocoagulation;the other 3 patients 3 eyes were not received the photocoagulation because of vitreous opacity. One patient was treated with glaucom a valve im plantation. Six patients with only neovascularization and without glaucom a were im proved in visual acuity whose intraocular pressure was controlled after com bined treatm ent. Of the patients with neovascular glaucom a（ n =12）,after intravitreal injection of lucentis and panretinal photocoagulation,the IOP was controlled in 4 patients（ 4eyes）; the IOP of another 7 cases reduced but glaucom a drugs were still needed. One patient（ 1 eye） received glaucom a valve im plantation because of bad control onIOP with worse vision after im plantation. The rubeosis disappeared in all patients.CONCLUSION： Intravitreal injection of lucentis can stop neovascularization and help to control IOP. In the early stage without neovascular glaucom a,lucentis has better effects,which m eans early detection and intervention are im portant.