Călugăru D, Călugăru M
Oftalmologia. 2012;56(3):20-39.
Neovascular glaucoma management is divided into preventive and curative procedures.Pre vention therapy consists of the treatment of the common underlying causes of the disease (ie diabetic retinopathy, ischemic central retinal vein occlusion and ocular ischemic syndrome) as well as the less frequent causes attributed to ocular radiation, ocular tumors, uveitis and other miscellaneous condi tions.Curative therapy includes both the neovascularization treatment and the treatment of the in creased intraocular pressure.lntravitreal Bevacizumab injection enables us to block up the neovascular trigger preparing thereby the pacient to a complement of panretinal photocoagulation or surgical treatment. Since Bevacizumab injection activity is transient, the retinal ischemia treatment by panretinal photocoagulation is mandeited in order to avoid neovascular recurrence.Short term efficacy of Bevacizumab injection is obvious with a constant, marked and swift intraocular pressure lowering espe cially in less severe and/or early forms of the disorder. In more advanced stages of neovascular glaucoma after closing the chamber angle by peripheric anterior synechiae the outcomes of this treatment are inconstant, most of cases necessitating the resorting to surgery (trabeculectomy with antifi brosis drugs or glaucoma drainage implants).
新生血管性青光眼的治疗分为预防性和治疗性程序。预防治疗包括治疗该疾病常见的潜在病因(即糖尿病视网膜病变、缺血性视网膜中央静脉阻塞和眼部缺血综合征)以及较少见的由眼部辐射、眼部肿瘤、葡萄膜炎和其他杂症引起的病因。治疗性治疗包括新生血管化治疗和眼内压升高的治疗。玻璃体内注射贝伐单抗使我们能够阻断新生血管触发因素,从而为患者进行全视网膜光凝或手术治疗做准备。由于贝伐单抗注射的活性是短暂的,因此需要进行全视网膜光凝治疗视网膜缺血,以避免新生血管复发。贝伐单抗注射的短期疗效明显,能持续、显著且迅速地降低眼压,尤其是在病情较轻和/或早期的病例中。在新生血管性青光眼的更晚期,周边前粘连导致房角关闭后,这种治疗的效果不稳定,大多数情况下需要采取手术治疗(使用抗纤维化药物的小梁切除术或青光眼引流植入物)。