| Background and PurposeNeovascular glaucoma(NVG) or Nascular insufficiency glaucoma, is a kind of destructive and blind refractory glaucoma. It has complex etiology. Main clinical manifestation of NVG is neovascularization of the iris (rubeosis iridis) or anterior chamber angle. Acute angle-closure glaucoma results initially from obstruction of the angle by the fibrovascular membrane, but subsequent contraction of the membrane leads to angle closure. In the study of the pathogenesis of NVG, VEGF is considered to be the key factor of neovascularization, combine with its receptor, and start the process of the mitosis of vascular endothelial cells.There are lots of methods for clinical treatment of NVG, but many are symptomatic treatment, the efficacy is much bad, especially the patients with fundus lesions. The main problem of the treatment is the intraocular pressure which caused by recurrence of new blood vessels, so NVG treatment focuses on retreating or preventing the new blood vessels and controlling the intraocular pressure. Studies have confirmed that blocking the process of VEGF combine with its receptor, can inhibit neovascularization. Avastin is an inhibitor of VEGF antiboby, the main role is blocking the combination, then inhibiting a series of reactions.In this study, first give comprehensive treatment for the patients with complicated fundus lesions, observe and assess the efficacy of intravitreal injection of Avastin, to find a effective method for NVG treatment.MethodsA prospective study.51(60eyes) patients with neovascular glaucoma who still had part of the vision were selected in the study. They received intravitreal injection of Avastin, then given different treatments after the angle of anterior chamer or the iris neovascularization faded. Such as compound trabeculectomy, cyclophotocoagulation, phacoemulsification, vitrectomy. Another two injections of Avastin were scheduled for each patient every4weeks after baseline observation. All of the eyes were measured the intraocular pressure before the injection and at1week,1month,6month and12month after surgery.All results are expressed as the Mean±SD. Statistical analyses were performed with SPSS17.0software. It was considered significant if P value was<0.05between groups.ResultsAfter3days of Avastin injecting, in47eyes, the angle of anterior chamber and the iris neovascularization faded completely. In7eyes, it’s within7days. Another6eyes, neovascularization faded partly. The mean IOP level was (42.92±9.874mmHg) before the intravitreal injection of Avastin, continued to offer drop intraocular pressure therapy and observed the reaction of anterior chamber, The mean IOP level was(31.04±8.008mmHg)before surgery, which had significant difference (P<0.001). Then given different surgery and regular injection. The mean IOP level of1week and1month,6and12months after the surgery were (14.97±2.727;15.42±2.604;16.94±3.827;19.17±5.029)mmHg respectively which were significant different from the mean IOP level preoperative (P<0.001). The visual acuity of45eyes was stable,9eyes rise slightly,6eyes descend slightly. The IOP were controlled completely in24eyes (40%), partly controlled in17eyes (28%), and not controlled in19eyes(32%). Conclusions1. After Avastin injecting, the angle of anterior chamber and the iris neovascularization faded completely or partly.2. The fading of new blood vessels, to avoid the subsequent surgical complications such as bleeding. It offers a window period in the treatment of glaucoma surgery, and also becomes a prerequisite for the treatment of NVG3. The average IOP after injecting and surgry are lower than before, and the records have statistically significant difference(P<0.05).4. NVG treatment should focus on inhibiting or preventing the formation of new blood vessels. In this study, anti VEGF drugs combines with Anti-glaucoma surgery can give a good effect. |
PDF Full Text Request