| Background and PurposeNeovascular glaucoma（NVG）is a kind of refractory "stubborn" secondaryglaucoma, it is Often secondary to Retinal ischemic diseases, such as diabeticretinopathy, central retinal vein occlusion, central retinal artery occlusion, retinalischemia syndrome etc. It possess faster develop-ment,higher blindness rate, eyepain, etc. Main pathological mechanism is the growth of new blood vessels whichcaused by retinal ischemic diseases, these new blood vessels distributed in the surfaceof iris and trabecular, these lead to trabecular meshwork obstruction, peripheral irisadhesion and angle closure, further caused intraocular pressure elevation, in this way,high intraocular pressure and ocular ischemia hypoxia affect the optic nerve andretinal function, which lead to visual impairment. In the pathogenesis of NVG, VEGFis considered to be the key factor of neovascularization, it is a kind of specificmitogen of vascular endothelial cells, the main role is to induce proliferation ofendothelial cell proliferation, promote blood vessel formation and increasemicrovascular permeability by combined with receptors.There are many methods forclinical treatment of NVG, but many are symptomatic treatment, including drugtherapy and filtration surgery, the efficacy is not obvious. The main cause of treatment failure is high intraocular pressure which caused by recurrence of newblood vessels.So the treatment of NVG should be to focuse on preventing oreliminating the new blood vessels and reducing the intraocular pressure.Studies haveshown that, Anti-VEGF drugs can effectively inhibit the neovascularization.Ranibizumab is an inhibitor of VEGF antibody, which can prevent combinating withVEGF receptors,then inhibiting the growth of new blood vessels. We should dofiltration surgery after the new blood vessels fade, it is can improve the success rateof surgery. This research is mainly to discuss the efficacy of intravitreal injection ofLucentis in the treatment of NVG and complications, to seek a new method for thetreatment of NVG.MethodsSelected from October2012to September2013in our hospital of30patients (30eyes) who have new blood vessels at the surface of the iris,they are caused by diabeticretinopathy and retinal vein occlusion.In these patients,20patients(20eyes) withdiabetic retinopathy,10patients(10eyes) with retinal vein occlusion.8patients （8eyes） with normal intraocular pressure(IOP)(IOP at10～21mmHg,called irisneovascularization group),22patient（s22eyes）with high IOP(IOP＞21mmHg,calledNVG group).Exclusion criteria included patients with no light perception and eyeballatrophy,retinal diseases such as retinal detachment, the previous history of eyedisease treatment,systemic surgical contraindications.They all received intravitrealinjection of Lucentis (10mg·ml-1)0.05ml, observing iris neovascularizationregression or atrophy after the drug injuction. All of the patients were measured theIOP before the drug injection and after3days. The patients whose IOP>21mmHgwere given anti-glaucoma drugs or performed trabeculectomy after the irisneovascularization faded. It is combined use antimetabolites of mitomycin. Thesepatients were measured the IOP before trabeculectomy and at1week,1month,3month,6month after surgery and observed the filtering bleb, complications. Statisticalanalyses were performed on the IOP by SPSS17.0statistical software,the results areexpressed with the Mean±Standard Deviation (x±s).It was considered significant if P value was less than0.05between groups (P <0.05).Results(1) After2～3days of intravitreal injection of Lucentis,in8eyes of irisneovascularization group and14eyes of NVG group, the iris neovascularizationcompletely faded, in6eyes, it is within4to7days, in2eyes, it is within mostly7days and the neovascularization faded partly,after two weeks, it is completely faded.During the follow-up period of6months,3eyes of rubeosis iridis and7eyes of NVGwith iris neovascularization recurrence.(2) In the iris neovascularization patients, the mean IOP level before injectionand after3days,1week,1month,3months,6months respectively were (17.63±1.85；17.38±3.99；16.38±2.33；16.63±1.77；18.00±1.85；19.00±1.41) mmHg,all withinthe normal range. During the follow-up period, the IOP elevated in2eyes with therecurrence of iris neovascularization. In the NVG patients, the mean IOP level was(46.41±8.20) mmHg before injection,the mean IOP level was (37.27±9.35) mmHgafter3days injection, compared with before injection, the mean IOP dropped (9.14±5.68)mmHg, the difference was statistically significant (t=7.55,P=0.000).The IOPdropped to normal in2eyes after injection,in3eyes,the IOP is normal after givenanti-glaucoma drugs in3to7days,17eyes whose IOP>21mmHg were performedtrabeculectomy, the mean IOP before surgery was(35.64±5.43),and at1week,1month,3months,6months after surgery respectively were (16.77±4.71,18.95±4.65,18.32±3.58,18.18±4.63) mmHg,compared with before surgery, the differencewas statistically significant（t=12.03，p=0.000; t=10.99，p=0.000; t=18.16，p=0.000;t=21.05，P=0.000）. The IOP was completely controlled in7eyes (41.18%),andpartly controlled in5eyes (29.41%),5eyes (29.41%) failed.(3) Compared with before treatment, the vision acuity of5eye iris neovas-cularization patients was increased after treatment,3eyes were stable. The visionacuity of17eyes of NVG patients was stable,3eyes were rise slightly,2eyes descendslightly.(4) The filtering blebs formed within3days after treatment for NVG patients with trabeculectomy, and they were all functional ones, during the follow-up periodof6months,10eyes (58.82%) were maintained functional filtering blebs.(5) there is no obvious complications for all eyes during the follow-up period of6months,4eyes with shallow anterior chamber and2eyes with anterior chamberbleeding after surgery.Conclusion1．Intravitreal injection of Lucentis is remarkably effect to eliminate irisneovascularization, but it is easy to relapse.2．Intravitreal injection of Lucentis reduced bleeding of the trabeculectomy andimproved the success rate of surgery. |
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