Bevacizumab球結膜下注射聯合滴眼液治療角膜新生血管

伊恩暉，王 懿，王麗麗

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·臨床報告·

Bevacizumab球結膜下注射聯合滴眼液治療角膜新生血管

伊恩暉，王 懿，王麗麗

Department of Ophthalmology,Xi’an Central Hospital, Xi’an 710003, Shaanxi Province, China

?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.

目的：觀察bevacizumab結膜下注射聯合眼液滴眼治療角膜新生血管(corneal neovascularization，CNV)的臨床效果及安全性。

方法：采用自身前后對照比較，觀察CNV患者25例32眼，其中堿燒傷6例8眼，慢性角膜炎14例19眼，單純角膜穿通傷5例5眼。采取患眼下方結膜下注射bevacizumab 2.5mg，治療后應用自配的5mg/mL bevacizumab眼液滴眼4次/d，連續滴眼15d。1mo后重復上述治療，共3次。于治療前、再次治療前和3次治療停止后1、3、6mo觀察視力、眼壓、前房反應、CNV面積、角膜血管翳及血壓、心率的變化情況，探討bevacizumab治療CNV的效果、治療次數和安全性。

結果：所有患者治療后血壓、心率、眼壓及前房反應與治療前無明顯變化，角膜血管翳有不同程度的減輕，平均CNV面積與治療前比較，差異有統計學意義(F=5.574、6.221、6.221，P<0.05)。治療停止后1mo，18眼(56%)視力提高兩行以上；20眼(63%)CNV面積減??；有效率為56%。3mo后23眼(72%)視力提高兩行以上；25眼(78%)CNV面積減小；有效率為72%。6mo后情況與3mo基本相同。bevacizumab對不同病因引起的CNV均表現出治療效果效果，堿燒傷、慢性角膜炎及單純角膜穿通傷的改善率分別為62%、79%和60%。在32眼中，觀察視力或CNV改善情況，第1次治療后44%得到改善，第2次治療后56%改善，第3次治療后63%改善，3次治療后兩組組間比較改善率，治療2次和3次與治療1次比較，差異均有統計學意義(χ2=46.274、48.532，P<0.05)。

結論：Bevacizumab結膜下注射聯合眼液滴眼治療CNV方法簡便，短期觀察效果明確，未見明顯不良反應。

bevacizumab；角膜新生血管/面積；角膜血管翳

引用：伊恩暉，王懿，王麗麗.Bevacizumab球結膜下注射聯合滴眼液治療角膜新生血管.國際眼科雜志2016;16(12):2302-2304

0引言

角膜新生血管(corneal neovascularization，CNV)的形成是在各種致病因素作用下，血管生成和抑制因素失去平衡，導致血管生成因素占主導地位而引起正常角膜血管化，造成角膜“免疫赦免”機制的破壞，失去透明性，造成視力下降。嚴重的角膜化學燒傷、炎癥、感染、外傷等均可以導致CNV的形成，是角膜盲的重要原因之一。CNV的治療一直是眼科研究的熱點和難點，傳統的治療方法都存在一定的局限性，我們通過對25例32眼角膜新生血管患者應用抗血管內皮生長因子重組人源化單克隆IgG抗體(bevacizumab)的觀察，取得了較好的臨床效果，現報告如下。……