Bevacizumab球结膜下注射联合滴眼液治疗角膜新生血管

摘要

目的：观察bevacizumab结膜下注射联合眼液滴眼治疗角膜新生血管( corneal neovascularization,CNV)的临床效果及安全性。方法：采用自身前后对照比较,观察 CNV 患者25例32眼,其中碱烧伤6例8眼,慢性角膜炎14例19眼,单纯角膜穿通伤5例5眼。采取患眼下方结膜下注射bevacizumab 2.5mg,治疗后应用自配的5mg/mL bevacizumab眼液滴眼4次/d,连续滴眼15d。1mo后重复上述治疗,共3次。于治疗前、再次治疗前和3次治疗停止后1、3、6 mo观察视力、眼压、前房反应、CNV面积、角膜血管翳及血压、心率的变化情况,探讨 bevacizumab 治疗CNV的效果、治疗次数和安全性。结果：所有患者治疗后血压、心率、眼压及前房反应与治疗前无明显变化,角膜血管翳有不同程度的减轻,平均CNV面积与治疗前比较,差异有统计学意义( F=5.574、6.221、6.221,P<0.05)。治疗停止后1mo,18眼(56%)视力提高两行以上；20眼(63%) CNV 面积减小；有效率为56%。3mo后23眼(72%)视力提高两行以上；25眼(78%) CNV面积减小；有效率为72%。6 mo后情况与3 mo基本相同。　　bevacizumab对不同病因引起的CNV均表现出治疗效果效果,碱烧伤、慢性角膜炎及单纯角膜穿通伤的改善率分别为62%、79%和60%。在32眼中,观察视力或CNV改善情况,第1次治疗后44%得到改善,第2次治疗后56%改善,第3次治疗后63%改善,3次治疗后两组组间比较改善率,治疗2次和3次与治疗1次比较,差异均有统计学意义(χ2=46.274、48.532,P<0.05)。结论：Bevacizumab结膜下注射联合眼液滴眼治疗CNV方法简便,短期观察效果明确,未见明显不良反应。%•AIM:To observe the safety and efficacy of topically administered bevacizumab by ways of subconjunctival injection and eye drops in the treatment of stable corneal neovascularization.•METHODS: With the way of comparison before and after treatment, 32 eyes (25 patients) diagnosed corneal neovascularization ( CNV ) were administrated bevacizumab by means of subconjunctival injection (2. 5mg) and eye drops (4 times/d) 15d, which included Alkali burn 6 inpatients 8 eyes, Chronic keratitis 14 inpatients 19 eyes and Simple corneal penetrating injury 5 inpatients 5 eyes. After one month, the patients were treated in the same way again. The treatments were total 3 times. Visual acuity, intraocular pressure ( IOP) , flare of the anterior chamber, area and length of CNV, corneal pannus, blood pressure and heart rate were observed before and after treatment. The efficacies, safety and frequency of Bevacizumab were discussed before treatments and after the three times treatments ending at 1, 2 and 6mo.• RESULTS: In 32 eyes, IOP, flare of the anterior chamber, blood pressure and heart rate were not changed and corneal pannus were alleviated in varying degrees after the treatments. Compared with the eyes before treatment, the efficacies after the three times treatments in 1, 2 and 3mo were statically significant differences (F=5. 574, 6. 221, 6. 221;P<0. 05). After the treatments of one month, visual acuity of 18 eyes were improved above two row (56%);area of CNV of 20 eyes were reduced (63%) and the efficacy was 56%. After the treatments of three months, visual acuity of 23 eyes were improved above two row ( 72%); area of CNV of 25 eyes were reduced ( 78%) and the efficacy was 72%. Changes after six months were the same as those after three months. As the different cases of CNV, the therapy of Bevacizumab was efficient. In 32 eyes, the improvements of Bevacizumab treatment in eyesight and CNV were 44% in one time, 56% in two times, and 63% in three times, the times of Bevacizumab treatment were statically significant differences compared one time with two or three times (χ2=46. 274, 48. 532;P<0. 05).• CONCLUSION: The mean of topically administered Bevacizumab by ways of subconjunctival injection and eye drops in the treatment of stable corneal neovascularization is simple, efficient and safe without local or systemic adverse effects in a short phase.