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玻璃体内注射贝伐单抗与房水引流手术治疗新生血管性青光眼:安全性与疗效

Intravitreal bevacizumab and aqueous shunting surgery for neovascular glaucoma: safety and efficacy.

作者信息

Eid Tarek M, Radwan Ashraf, el-Manawy Wael, el-Hawary Ihab

机构信息

Department of Ophthalmology, Tanta University, Egypt.

出版信息

Can J Ophthalmol. 2009 Aug;44(4):451-6. doi: 10.3129/i09-108.

Abstract

OBJECTIVE

To study the safety and efficacy of intravitreal injection of bevacizumab followed by aqueous shunting tube surgery for the management of neovascular glaucoma (NVG).

STUDY DESIGN

A prospective, non-randomized study with a historical control group.

PARTICIPANTS

Twenty eyes of 20 patients with intractable NVG were treated with intravitreal injection of bevacizumab followed by aqueous shunting surgery (IVB group). A historical group of 10 NVG eyes treated with panretinal photocoagulation followed by aqueous shunting surgery without bevacizumab injection was used for comparison (PRP group).

METHODS

Injection of bevacizumab (1.25 mg/0.05 mL) was performed under topical anesthesia. An Ahmed valve was implanted in all cases after 1-2 weeks. In the IVB group, 10 eyes received postoperative panretinal photocoagulation (subgroup 1A), and 10 eyes were followed without further photocoagulation (subgroup 1B). Minimum follow-up was 1 year or when failure was diagnosed.

RESULTS

Mean preoperative intraocular pressure (IOP) was 46.5 mm Hg in the IVB group and 49.2 mm Hg in the PRP group (p = 0.5). After bevacizumab injection, iris neovessels regressed markedly. The final IOP after aqueous shunting tube surgery was 18.8 mm Hg in the IVB group and 15.9 mm Hg in the PRP group (p = 0.2). Postsurgical complications were comparable between the groups. The success rate was 85% and 70% in the 2 groups, respectively. Two eyes were considered failures, and 3 required repeated bevacizumab injections in subgroup 1B as compared with 1 in subgroup 1A.

CONCLUSION

Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in NVG. Panretinal photocoagulation after bevacizumab injection promotes the success rate of aqueous shunt surgery by permanent ablation of the ischemic retina.

摘要

目的

研究玻璃体内注射贝伐单抗联合房水引流管手术治疗新生血管性青光眼(NVG)的安全性和有效性。

研究设计

一项设有历史对照组的前瞻性、非随机研究。

研究对象

20例难治性NVG患者的20只眼接受玻璃体内注射贝伐单抗联合房水引流手术治疗(IVB组)。选取10只接受全视网膜光凝联合房水引流手术且未注射贝伐单抗的NVG眼作为历史对照组(PRP组)进行比较。

方法

在表面麻醉下注射贝伐单抗(1.25 mg/0.05 mL)。1 - 2周后所有病例均植入艾哈迈德引流阀。IVB组中,10只眼接受术后全视网膜光凝(1A亚组),10只眼未进行进一步光凝随访观察(1B亚组)。最短随访时间为1年或诊断为失败时。

结果

IVB组术前平均眼压(IOP)为46.5 mmHg,PRP组为49.2 mmHg(p = 0.5)。注射贝伐单抗后,虹膜新生血管明显消退。房水引流管手术后IVB组最终眼压为18.8 mmHg,PRP组为15.9 mmHg(p = 0.2)。两组术后并发症相当。两组成功率分别为85%和70%。1B亚组有2只眼被视为治疗失败,3只眼需要重复注射贝伐单抗,而1A亚组为1只眼。

结论

玻璃体内注射贝伐单抗是在NVG中安全有效地植入房水引流管的有用预备步骤。贝伐单抗注射后进行全视网膜光凝通过永久性消融缺血视网膜提高了房水引流手术的成功率。

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