Objective To evaluate the long-term efficacy of intravitreal Bevacizumab (IVB) combined with trabeculectomy and panretinal photocoagulation (PRP) in the management of neovascular glaucoma. Methods It was a retrospective case series study. Eighteen eyes of 17 patients with neovascular glaucoma were included. Patients first received an intravitreal injection of Bevacizumab (1.25 mg in 0.05 ml). Trabeculectomy with intraoperative mitomycin C was then performed after the complete regression of neovascularization of the iris (NVI). PRP or supplementary photocoagulation was performed postoperatively. Compare the intraocular pressure (IOP) pre-IVB, pre-trabeculectomy and 1 week, 1 month, 3 months, 6 months, 12 months after trabeculectomy and the final visit. In addition, pre-IVB visual acuity (VA) was compared to VA at the final visit. The follow-up period ranged from 12 to 32 months, mean 20.5±7.4 months. Data were analyzed with paired t test and one-way ANOVA. Results NVI completely regressed in 18 of the eyes after IVB. The mean time for regression was 3.7±1.4 days (range from 2 to 7 days). Pre-IVB mean IOP was 51.9±10.9 mmHg, with 3.9±0.7 anti-glaucoma medications, and the mean logMAR VA was 2.26±0.43. Mean IOPs were 45.2±7.1, 8.6±2.1, 13.9±6.3, 16.5±6.9, 17.7±7.2, 19.2±7.8, 16.1±3.7 mmHg before trabeculectomy and at postoperative 1 week, 1 month, 3 months, 6 months, 12 months and the final visit, respectively. The reduction between pre-trabeculectomy IOP and pre-IVB IOP was statistically significant (t=5.437, P<0.05). The reduction between post-trabeculectomy IOPs and pre-trabeculectomy IOP was statistically significant (F=64.79, P<0.05). At the final visit, only 3 eyes were using anti-glaucoma medications, and the mean LogMAR VA was 2.1±0.6. The change in the mean LogMAR VA was not statistically significant. Recurrence of NVI occurred in 4 eyes, two of which received ciliary photocoagulation. The complete success, qualified success and failure at the final visit was 13 eyes, 3 eyes and 2 eyes, respectively. Conclusion IVB combined with trabeculectomy and PRP is an effective method for controlling intraocular pressure in NVG over the long term.
庄岩,陈有信. 玻璃体腔注射Bevacizumab联合小梁切除术及全视网膜光凝治疗新生血管性青光眼[J]. 中华眼视光学与视觉科学杂志, 2013, 15(3): 164-168.
ZHUANG Yan,CHEN You-xin. Efficacy of intravitreal Bevacizumab combined with trabeculectomy and panretinal photocoagulation in the management of neovascular glaucoma. Chinese Journal of Optometry Ophthalmology and Visual Science, 2013, 15(3): 164-168. DOI: 10.3760/cma.j.issn.1674-845X.2013.03.009
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