Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
Graefes Arch Clin Exp Ophthalmol. 2013 Oct;251(10):2403-13. doi: 10.1007/s00417-013-2428-y. Epub 2013 Jul 28.
To evaluate the capability of adjuvant intraocular ranibizumab (Lucentis) injections in the treatment of rubeosis and intraocular pressure in patients with rubeosis and neovascular glaucoma.
Ten eyes with rubeosis (R) and ten eyes with neovascular glaucoma (NVG) received Lucentis injections (ranibizumab 0.5 mg/0.05 ml) in this prospective, monocenter, 12-months, interventional case series. The primary efficacy outcome measure was the change of degree of iris rubeosis as documented by iris fluorescein angiography measured after 12 months. Secondary outcomes were intraocular pressure (IOP), best-corrected visual acuity (BCVA, logMAR), numbers of additional interventions or antiglaucoma medications administered after injection, the gonioscopic status of the anterior chamber angle, and central retinal thickness.
In the R group, 3.6 injections and in the NVG group 2.3 injections of Lucentis were administered. Additional treatments were photocoagulation (n = 19), cyclodestructive procedures (n = 9), cryopexy (n = 3), and vitrectomy (n = 1). The mean stage of rubeosis was 3.4 ± 0.7 in the R group and 3.6 ± 0.8 in the NVG group at baseline. At month 12, the rubeosis was almost resolved in the R group (0.1 ± 0.3, p < 0.001), and decreased significantly in the NVG group (0.7 ± 1.1, p < 0.001). In the NVG subgroup, mean IOP was 41.4 ± 13.4 mmHg at baseline, which decreased rapidly (18.2 ± 12.3, day-14, p = 0.005) and stabilized during the follow-up (15.6 ± 2.0 mmHg, p < 0.05). BCVA improved significantly in both groups (p < 0.05, at month 12).
Injection of 0.5 mg ranibizumab appears to be beneficial as an adjuvant treatment in neovascular glaucoma and rubeosis due to its anti-angiogenic properties and its ability to prevent establishment or progression of anterior chamber angle obstruction. Conventional therapeutic procedures addressing the retinal ischemia are still required in a stage-wise treatment approach.
评估辅助性眼内雷珠单抗（Lucentis）注射治疗新生血管性青光眼伴虹膜新生血管和眼内压的能力。
本前瞻性、单中心、12 个月、干预性病例系列研究纳入了 10 只患有虹膜新生血管（R 组）和 10 只患有新生血管性青光眼（NVG 组）的眼。主要疗效评估指标为治疗 12 个月后虹膜荧光素血管造影测量的虹膜新生血管程度变化。次要结局指标包括眼内压（IOP）、最佳矫正视力（BCVA，logMAR）、注射后额外干预或抗青光眼药物的使用次数、前房角的房角状态和中心视网膜厚度。
R 组中，10 只眼接受了 3.6 次 Lucentis 注射，NVG 组中 10 只眼接受了 2.3 次 Lucentis 注射。此外，还进行了光凝治疗（n = 19）、破坏性小梁切除术（n = 9）、冷冻治疗（n = 3）和玻璃体切除术（n = 1）。R 组的虹膜新生血管平均分期为 3.4 ± 0.7，NVG 组为 3.6 ± 0.8。治疗 12 个月后，R 组的虹膜新生血管几乎消退（0.1 ± 0.3，p < 0.001），NVG 组虹膜新生血管显著减少（0.7 ± 1.1，p < 0.001）。在 NVG 亚组中，基线时平均眼压为 41.4 ± 13.4mmHg，治疗后迅速下降（第 14 天，18.2 ± 12.3mmHg，p = 0.005），随访期间眼压稳定（15.6 ± 2.0mmHg，p < 0.05）。两组的 BCVA 均显著改善（p < 0.05，治疗 12 个月时）。
0.5mg 雷珠单抗注射具有抗血管生成作用，能预防前房角阻塞的发生或进展，作为新生血管性青光眼和虹膜新生血管的辅助治疗方法可能有益。在分阶段治疗方法中，仍然需要针对视网膜缺血的常规治疗方法。
