Wakabayashi Taku, Oshima Yusuke, Sakaguchi Hirokazu, Ikuno Yasushi, Miki Atsuya, Gomi Fumi, Otori Yasumasa, Kamei Motohiro, Kusaka Shunji, Tano Yasuo
Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan.
Ophthalmology. 2008 Sep;115(9):1571-80, 1580.e1-3. doi: 10.1016/j.ophtha.2008.02.026. Epub 2008 Apr 28.
To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with ischemic retinal disorders.
Retrospective, consecutive, interventional case series.
Thirty patients (41 eyes) with INV or NVG secondary to ischemic retinal disorders.
Patients received IVB (1 mg) as the initial treatment for INV or NVG and were followed up for at least 6 months. Ophthalmic evaluations included measurement of visual acuity and intraocular pressure (IOP), a complete ophthalmic examination, and fluorescein angiography. Patients were divided into 3 subgroups: INV without elevated IOP (INV group), NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group) for outcomes analysis.
The controllability of IOP by IVB, incidence of recurrence, and requirement for surgery to treat NVG.
No significant ocular or systemic adverse events developed during follow-up (range, 6-22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9 mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV group (9 eyes), the INV regressed or resolved after 1 injection. Iris neovascularization recurred in 4 eyes by 6 months and stabilized after repeated injections without IOP elevation. In the O-NVG group (17 eyes), rapid neovascular regression with successful IOP normalization (<or=21 mmHg) occurred in 12 eyes (71%) within 1 week after 1 injection. Five (29%) of the 17 eyes required surgery by 6 months despite repeated IVB injections, and a total of 7 eyes (41%) underwent surgery during follow-up. In the C-NVG group (15 eyes), IVB caused INV resolution but failed to lower the IOP. Fourteen (93%) of 15 eyes required surgery by 2 months after initial IVB and achieved IOP stabilization. The mean interval between IVB and surgery was significantly shorter in the C-NVG group than in the O-NVG group (P<0.001).
Intravitreal bevacizumab is well tolerated, effectively stabilized INV activity, and controlled IOP in patients with INV alone and early-stage NVG without angle closure. In advanced NVG, IVB cannot control IOP but may be used adjunctively to improve subsequent surgical results. Further evaluation in controlled randomized studies is warranted.
评估玻璃体内注射贝伐单抗（IVB）治疗缺血性视网膜疾病患者虹膜新生血管（INV）或新生血管性青光眼（NVG）的生物学疗效。
回顾性、连续性、干预性病例系列研究。
30例（41只眼）继发于缺血性视网膜疾病的INV或NVG患者。
患者接受IVB（1mg）作为INV或NVG的初始治疗，并随访至少6个月。眼科评估包括视力和眼压（IOP）测量、全面的眼科检查以及荧光素血管造影。为进行结果分析，将患者分为3个亚组：眼压未升高的INV（INV组）、开角型NVG（O-NVG组）和闭角型NVG（C-NVG组）。
IVB对眼压的控制能力、复发率以及治疗NVG所需的手术情况。
随访期间（6 - 22个月；平均13.3个月）未发生明显的眼部或全身不良事件。INV组、O-NVG组和C-NVG组基线时的平均眼压分别为14.7、31.2和44.9 mmHg。在INV组（9只眼）中，1次注射后INV消退或消失。6个月时4只眼虹膜新生血管复发，重复注射后病情稳定且眼压未升高。在O-NVG组（17只眼）中，1次注射后1周内12只眼（71%）新生血管迅速消退且眼压成功恢复正常（≤21 mmHg）。17只眼中有5只眼（29%）尽管重复注射IVB，但6个月时仍需手术，随访期间共有7只眼（41%）接受了手术。在C-NVG组（15只眼）中，IVB使INV消退，但未能降低眼压。15只眼中有14只眼（93%）在首次IVB注射后2个月内需手术，且眼压得以稳定。C-NVG组IVB与手术之间的平均间隔时间显著短于O-NVG组（P<0.001）。
玻璃体内注射贝伐单抗耐受性良好，能有效稳定INV活动，并控制单纯INV患者及早期无闭角的NVG患者的眼压。在晚期NVG中，IVB无法控制眼压，但可辅助使用以改善后续手术效果。有必要在对照随机研究中进行进一步评估。
