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玻璃体内注射贝伐单抗治疗视网膜脱离玻璃体视网膜手术后医源性脉络膜新生血管膜

Intravitreal bevacizumab for iatrogenic choroidal neovascular membrane following vitreoretinal surgery for retinal detachment.

作者信息

Appanraj Ramya, Duraiswamy Hema, Saravanan Veerappan, Manayath George, Venkatapathy Narendran

机构信息

Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India.

出版信息

Indian J Ophthalmol. 2020 Jun;68(6):1201-1203. doi: 10.4103/ijo.IJO_1486_19.

Abstract

We report the successful use of intravitreal bevacizumab in the iatrogenic choroidal neovascular membrane (CNVM) following vitreoretinal surgery. A 69-year-old male underwent vitrectomy surgery with silicone oil (SO) tamponade for rhegmatogenous retinal detachment. During fluid air exchange, there was an accidental retinal touch at an area in the papillomacular bundle with the silicone tip cannula. He had persistent subretinal bleed at the area 1 month after surgery. The optical coherence tomography (OCT) showed a subretinal elevated lesion and fluorescein angiography (FFA) showed an active CNVM. The patient was treated with intravitreal bevacizumab in the SO-filled eye. At 1-month postinjection, the OCT revealed reduction in the size of CNVM. The patient underwent SO removal with the second dose of intravitreal bevacizumab. CNVM regressed with no recurrence on follow-up at 1 year. Iatrogenic CNVM is a rare complication following successful vitreoretinal surgery. Prompt diagnosis and treatment with intravitreal bevacizumab may be required for a favorable outcome. Iatrogenic choroidal neovascular membrane (CNVM) is an uncommon condition usually associated with retinal laser or iatrogenic trauma during vitrectomy. Very few cases of iatrogenic CNVM have been reported in the literature, and the functional outcome has generally been poor in these reports despite treatment with laser photocoagulation, intravitreal bevacizumab, photodynamic therapy, and surgical removal of neovascular membranes. We report this case to highlight this rare complication following vitrectomy and its response to antivascular endothelial growth facor (VEGF) therapy.

摘要

我们报告了玻璃体内注射贝伐单抗成功用于玻璃体视网膜手术后医源性脉络膜新生血管膜(CNVM)的治疗。一名69岁男性因孔源性视网膜脱离接受了玻璃体切除联合硅油(SO)填充手术。在液气交换过程中,硅胶头套管意外触碰了乳头黄斑束区域的视网膜。术后1个月,该区域持续存在视网膜下出血。光学相干断层扫描(OCT)显示视网膜下有隆起病变,荧光素血管造影(FFA)显示有活动性CNVM。该患者在硅油填充眼内接受了玻璃体内注射贝伐单抗治疗。注射后1个月,OCT显示CNVM大小缩小。患者在注射第二剂玻璃体内贝伐单抗时接受了硅油取出术。随访1年,CNVM消退且无复发。医源性CNVM是玻璃体视网膜手术成功后的一种罕见并发症。为获得良好预后,可能需要及时诊断并使用玻璃体内贝伐单抗进行治疗。医源性脉络膜新生血管膜(CNVM)是一种不常见的情况,通常与视网膜激光治疗或玻璃体切除术中的医源性创伤有关。文献中报道的医源性CNVM病例很少,并且尽管采用了激光光凝、玻璃体内注射贝伐单抗、光动力疗法以及手术切除新生血管膜等治疗方法,但这些报告中的功能预后总体较差。我们报告此病例以强调玻璃体切除术后这种罕见并发症及其对抗血管内皮生长因子(VEGF)治疗的反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26a7/7508106/d2bee95c26af/IJO-68-1201-g001.jpg

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