Biteli Luis Gustavo, Prata Tiago Santos
Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 820, Vila Clementino, São Paulo, Brazil.
Int Ophthalmol. 2013 Dec;33(6):741-6. doi: 10.1007/s10792-012-9704-4. Epub 2013 Feb 7.
To investigate subconjunctival bevacizumab as an adjuvant in first-time glaucoma filtration surgery, we conducted a non-comparative, interventional case series, enrolling consecutive patients with uncontrolled primary glaucomas. All patients underwent trabeculectomy with mitomycin C and received a 1.25 mg subconjunctival bevacizumab injection at completion of the surgery. Main outcome measurements were success rates, bleb morphology [standardized classification based on vascularity (0-1), extension (0-1) and height (0-1); ranging from 0 to 3 (0 = poor; 1 = regular; 2 = good; 3 = excellent)] and post-operative complications. Twenty-five eyes from 25 patients (mean age 64.3 ± 12.8 years) were included. After a mean follow-up of 16.7 ± 6.1 months, mean intraocular pressure (IOP) was significantly reduced from 22.7 ± 10.8 to 12.9 ± 4.3 mmHg at the last follow-up (p < 0.01). Complete success rates at 12 months ranged between 71 and 88 %, while qualified success rates ranged between 84 and 96 %, depending on the criterion adopted (the strictest success criterion was defined as IOP between 6 and 12 mmHg). Blebs were graded as good or excellent in 80 % of the cases. No serious post-operative complication or avascular blebs were observed. These mid-term results suggest subconjunctival bevacizumab as a safe and effective adjuvant in first-time filtration surgery for primary glaucoma patients.
为研究结膜下注射贝伐单抗在初次青光眼滤过手术中的辅助作用，我们开展了一项非对照性干预病例系列研究，纳入了连续的原发性青光眼控制不佳的患者。所有患者均接受了丝裂霉素C小梁切除术，并在手术结束时接受了1.25mg结膜下贝伐单抗注射。主要观察指标为成功率、滤过泡形态[根据血管化程度（0 - 1）、范围（0 - 1）和高度（0 - 1）进行标准化分类；范围为0至3（0 = 差；1 = 正常；2 = 良好；3 = 优秀）]及术后并发症。纳入了25例患者的25只眼（平均年龄64.3±12.8岁）。平均随访16.7±6.1个月后，末次随访时平均眼压（IOP）从22.7±10.8显著降至12.9±4.3mmHg（p < 0.01）。根据采用的标准，12个月时的完全成功率在71%至88%之间，而合格成功率在84%至96%之间（最严格的成功标准定义为眼压在6至12mmHg之间）。80%的病例滤过泡分级为良好或优秀。未观察到严重的术后并发症或无血管滤过泡。这些中期结果表明，结膜下贝伐单抗在原发性青光眼患者初次滤过手术中是一种安全有效的辅助药物。
