辅助玻璃体内注射贝伐单抗联合小梁切除术与单纯小梁切除术治疗新生血管性青光眼。

Adjunctive intravitreal bevacizumab-combined trabeculectomy versus trabeculectomy alone in the treatment of neovascular glaucoma.

机构信息

Department of Ophthalmology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

出版信息

J Ocul Pharmacol Ther. 2010 Feb;26(1):111-8. doi: 10.1089/jop.2009.0055.

DOI:10.1089/jop.2009.0055

PMID:20148654

Abstract

PURPOSE

To evaluate the effect of adjunctive intravitreal bevacizumab (ivBe) with trabeculectomy versus trabeculectomy alone in the management of patients with neovascular glaucoma (NVG).

METHODS

Retrospective, consecutive, interventional case series. NVG patients were divided into groups by treatment: with adjunctive ivBe and trabeculectomy (ivBe group, n = 14 eyes) and with trabeculectomy only (control group, n = 28 eyes). The main outcome measure was visual acuity. Regression of iris neovascularization (NVI), change(s) in intraocular pressure (IOP), NVI recurrence, additional glaucoma surgeries required, eyes of leading to total blindness, intraoperative and postoperative complications, and number of topical medications required after trabeculectomy were regarded as second outcome measures. In the ivBe group, intravitreal injections of 2.5 mg bevacizumab were delivered using a sharp 27-gauge needle through the inferotemporal quadrant.

RESULTS

Of 42 eyes of 42 patients identified, change in IOP, additional glaucoma surgeries required, and number of IOP-lowering topical medications required after trabeculectomy did not differ significantly between groups (P > 0.05 for all). However, the ivBe group had significantly higher frequency and rapidity of iris neovascular regression, improved visual acuity in the logarithm of minimum angle of resolution (logMAR), leading to total blindness in fewer eyes and intraoperative and postoperative complications in others than in the control group (P = 0.015, 0.002, 0.007, 0.023, and 0.008, respectively). The follow-up duration (mean +/- SD) from trabeculectomy surgery was 179 +/- 97 days (range, 93-315 days) and 196 +/- 108 days (range, 92-370 days) in the ivBe and control group (P = 0.324).

CONCLUSIONS

Intravitreal bevacizumab might be a useful adjunctive therapy in addition to trabeculectomy in the management of NVG. Large controlled randomized studies for treatment of bevacizumab on NVG are warranted.

摘要

目的

评估玻璃体内注射贝伐单抗（ivBe）联合小梁切除术与单纯小梁切除术治疗新生血管性青光眼（NVG）的疗效。

方法

回顾性、连续、干预性病例系列研究。根据治疗方法将 NVG 患者分为两组：玻璃体内注射贝伐单抗联合小梁切除术（ivBe 组，n=14 眼）和单纯小梁切除术（对照组，n=28 眼）。主要观察指标为视力。虹膜新生血管（NVI）消退、眼内压（IOP）变化、NVI 复发、需要额外的青光眼手术、导致完全失明的眼数、术中及术后并发症以及小梁切除术后所需的局部药物数量被视为次要观察指标。在 ivBe 组中，通过颞下象限的 27 号锐针注射 2.5mg 贝伐单抗。

结果

在 42 例 42 只眼中，两组间眼压变化、小梁切除术后需要的额外青光眼手术数量以及所需的降眼压局部药物数量差异无统计学意义（P＞0.05）。然而，ivBe 组虹膜新生血管消退的频率和速度更快，对数最小分辨角视力（logMAR）的视力改善，导致完全失明的眼数更少，其他眼的术中及术后并发症更少，与对照组相比差异有统计学意义（P=0.015，0.002，0.007，0.023 和 0.008）。从小梁切除术到随访结束的时间（均值±标准差）ivBe 组为 179±97 天（范围，93-315 天），对照组为 196±108 天（范围，92-370 天）（P=0.324）。