血管新生緑内障に対するベバシズマブ併用線維柱帯切除術の術後成績

Outcome of trabeculectomy with prior intravitreal bevacizumab injection for neovascular glaucoma

要約　目的：血管新生緑内障に対する線維柱帯切除術の成績に，ベバシズマブの術前硝子体投与の有無が及ぼす影響の比較。対象と方法：過去39か月間に線維柱帯切除術を行った24例26眼を診療録に基づいて検索した。原因疾患は糖尿病網膜症17眼，網膜静脈閉塞症6眼，その他3眼である。26眼中9眼にはベバシズマブの硝子体注入を行い，2週間以内に線維柱帯切除術を行った。結果：術後最終受診時の平均眼圧は，ベバシズマブ投与群が11.0±1.4mmHg，非投与群が9.0±1.4mmHgで，両群とも有意に眼圧が下降した。眼圧が15mmHg以上または緑内障に対する術後追加処置を死亡としたときの生存率は，術後12か月で投与群77.7％，非投与群60.0％であり，両群間に有意差はなかった。結論：ベバシズマブの術前硝子体中投与で，線維柱帯切除術の術後合併症が軽減し，早期の眼圧コントロールが得られる可能性がある。

Abstract.　Purpose：To compare the outcome of trabeculectomy for neovascular glaucoma with or without prior intravitreal injection of bevacizumab. Cases and Method：We reviewed 26 eyes of 24 cases who received trabeculectomy during the past 39 months. Neovascular glaucoma was due to diabetic retinopathy 17 eyes,retinal vein occlusion 6 eyes,and others 3 eyes. Nine eyes received intravitreal bevacizumab one to 14 days before surgery. Results：Final intraocular pressure（IOP）averaged 11.0±1.4 mmHg in 9 eyes receiving bevacizumb and 9.0±1.4 mmHg in the other 17 eyes. When final IOP over 15 mmHg or additional treatment glaucoma was defined as death,rate of survival was 77.7％ in 9 eyes receiving bevacizumab and 60.0％ in the other 17 eyes 12 months after surgery. There was no significant difference between the two groups. Conclusion：Intravitreal injection of bevacizumab may decrease late complications of trabeculectomy and may induce early IOP control.