作者：刘涛 作者单位：（723000）中国陕西省汉中市3201医院眼科
【摘要】 目的:观察眼前房注射Bevacizumab(avastin)对虹膜红变的疗效及安全性。方法:5例（5眼）虹膜红变者分别继发于糖尿病视网膜病变，静脉周围炎，静脉阻塞。其中2例为玻璃体切割术后硅油填充眼，给予前房注射0.03ml(0.75mg)Bevacizumb(avastin)。其中1例联合小梁切除手术，1例联合睫状体冷凝术。结果:所有手术眼虹膜新生血管迅速消退，眼内压在联合使用抗青光眼手术或药物后降低，随访2~5mo没有虹膜红变复发，眼内压控制良好。结论:前房注射Bevacizumab(avastin)有效地减轻了虹膜红变，特别是在一些不适合玻璃体腔注射的病例，短期的研究随访证实前房注射迅速消退虹膜新生血管且无明显副作用。
【关键词】 前房;虹膜红变;曲安奈德Bevacizumab（Avastin)
Intracameral bevacizumab for treatment of iris rubeosis
Tao Liu
Department of Ophthalmology,No.3201 Hospital,Hanzhong 723000,Shannxi Province,China
Correspondence to: Tao Liu. Department of Ophthalmology,No.3201 Hospital,Hanzhong 723000,Shannxi Province,China. [email protected]
AbstractAIM: To report the curative effect and safty of intracameral bevacizumab (avastin) in patients with rubeosis iridis. METHODS: 5 cases (5 eyes) with iris rubeosis secondary to diabetic retinopathy, retinal periphlebitis (Eales disease) and branch/central retinal vein occlusion, among which 2 cases were silicon oil eyes and were performed intracameral bevacizumab(avastin) 0.03 cc (0.75mg) , one case is combined with trabeculectomy, and another with cyclocryosurgery. RESULTS: The rubeosis of all cases disappeared quickly, meanwhile the intraocular pressure decreased to normal range with the help of antiglaucoma operation and medicine.There are not any sign of rubeosis again in the 25 months followup visits and intraocular pressure were wellcontrolled. CONCLUSION: Intracameral bevacizumab (avastin) was an effective treatment for rubeosis, esp, for some cases that can not be injected to vitreous cavity. Short term study of intracameral bevacizumab demonstrated rapid regression of rubeosis and welltolerated injection with no obvious side effects.
KEYWORDS: intracameral; iris rubeosis; Bevacizumab (Avastin)
INTRODUCTION
Vascular endothelial growth factor (VEGF) plays an important role in the formation of neovascula in proliferative diabetic retinopathy, central retinal vein occlusion and other abnormal vessel diseases[1]. Until the appearance of inhibitor of VEGF, there isnt a satisfied way for the rubeosis derived from abnormal retinal blood vessels to be treated.
Recently, intravitreal injection of Bevacizumab has been reported to show effect in regression of iris rubeosis. This report demonstrates rapid improvement of rubeosis iridis by intracameral injection of Bevacizumab (avastin).
CASE REPORT
Case 1 A 57yearold man who had underwent Pars Plana Vitrectomy (PPV) with incompleted membrane peeling, panretinal photocoagulation and silicon oil tamponaded for proliferative diabetic retinopathy half a year ago presented vision loss in left eye. Unfortunately, even after surgery, anterior and posterior segment neovascularization developed in an active way. The ophthalmic examination showed that the intraocular pressure (IOP) was 67 mmHg and neovascular glaucoma was diagnosed. No medicine worked effectively in the management of his left eye and there were no reports about the intravitreal injection of Avastin in silicon oil tamponade eye. Surely, after extensive discussions about the potential systemic and ocular side effects, we got the agreement of patient himself to inject the 0.75mg 0.03mL avastin into anterior chamber of left eye. A dramatic reduction of iris neovascular was observed and the IOP was 42 mmHg on the first day after surgery. All the rubeosis iridis disappeared on the second day, but the IOP was around 30~40mmHg. So the cyclocryosurgery was performed. IOP decreased to 16 mmHg 1 week later. 5 months followup visits had been carried out until number. The IOP was 17mmHg, and there is no sign of rubeosis.
Case 2 A 21yearold man presented retinal periphlebitis (Eales disease) of both eyes. He had lost his left eye vision acuity 2 months ago and felt blurred in the right eye. The visual acuity of his right and left eyes were 0.1 and light perception respectively. Severe vitreous hemorrhage without any sign of rubeosis iridis was observed in the left eye and B ultrasound exam showed that there was tractional retina detachment. Mild vitreous hemorrhage, retinal hemorrhage and neovascular were observed in the right eye. The neovascular membrane failed to be removed completely for the bleeding during PPV in the left eye. 3 weeks postoperatively, he felt no light perception in the left eye. The rubeosis was observed under slitlamp exam and the IOP increased to 56 mmHg. With intracameral injection of avastin 0.03cc, 0。75mg, rubeosis was no longer visible by slitlamp examination and IOP decreased to 32mmHg 24 hours later, and the IOP was 18mmHg 7 days later. To our astonishment, the patient told us he got visual acuity again 3 months later. The visual acuity of the left eye recovered unbelievably to 0.02.
Case 3 A 66yearold lady with central retinal vein occlusion in right eye for 2 years presented rubeosis and neovascular glaucoma for 2 months. The VA was 0.1 and IOP increased to 45mmHg. The Gonioscopy of right eye showed closed angle with neovascularization. She signed a comprehensive consent after discussion of the potential risks and benefits of Bevaciazumab (avastin). Rubeosis was no longer visible under slitlamp examination 24 hours after intracameral injection of avastin 0.03 cc, 0.75mg. The injection was tolerated without obvious side effects. Due to the closed anterior chamber angle, the IOP decreased little. Then she underwent trabeculectomy, during which there were no obvious bleeding and the filter bulb was well established, IOP declined to 12mmHg. There are not any sign of rubeosis 4 months later.
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