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 statisticallysignificant.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.%目的 探讨玻璃体腔注射Bevacizumab (IVB)联合小梁切除术、全视网膜光凝(PRP)治疗新生血管性青光眼(NVG)的长期疗效.方法 回顾性系列病例研究.分析保守治疗均无法控制眼压NVG患者17例(18眼)的临床资料.患者先行IVB,待虹膜新生血管(NVI)消退后,行小梁切除术,术中使用丝裂霉素C,术后补充或完成PRP.比较IVB术前,小梁切除术前,术后1周、1个月、3个月、6个月、12个月以及末次随访时眼压,以及IVB术前和末次随访时视力.小梁切除术后随访12～32个月,平均(20.5±7.4)个月.采用配对t检验和单因素方差分析.结果 IVB后18眼NVI均消退,平均消退时间为(3.7±1.4)d(2～7 d).IVB术前平均眼压(51.9±10.9)mmHg,平均用药(3.9±0.7)种,平均logMAR视力2.26±0.43.小梁切除术前,术后1周、1个月、3个月、6个月、12个月以及末次随访时平均眼压分别为(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,小梁切除术前和IVB术前眼压相比差异具有统计学意义(t=5.437,P＜0.05),小梁切除术后各时间点和小梁切除术前眼压相比差异具有统计学意义(F=64.79,P＜0.05).末次随访时,只有3眼在用药,平均logMAR视力为2.1±0.6,与IVB术前相比差异无统计学意义.术后4眼NVI复发,2眼接受睫状体光凝治疗.手术完全成功13眼,部分成功3眼,失败率为2眼.结论 IVB联合小梁切除术、PRP能够长期控制NVG眼压.
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