玻璃体内注射贝伐单抗成功治疗圆形屈曲手术后虹膜红肿前段缺血:一例报告和文献回顾。

K Janssens, T Zeyen, J Van Calster
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引用次数: 0

摘要

目的:报告一例高度近视患者在环形屈曲手术后出现前段缺血(ASI)并虹膜红斑症,经第二次玻璃体内注射贝伐单抗成功治疗。方法:病例报告和文献复习。讨论:ASI是一种罕见但潜在严重的后段手术并发症。最后,由于虹膜红肿导致新生血管性青光眼。围带可以通过不同的方式损害前段循环:通过操纵或脱离直肌,通过压迫阻塞旋涡静脉或通过改变虹膜和睫状体的血液供应。该患者继发于ASI的虹膜红斑。第二次玻璃体内注射贝伐单抗一个月后,虹膜红肿有显著的消退。其他使用贝伐单抗治疗新生血管性青光眼的病例报告显示,这些患者的临床改善,眼压控制和新生血管形成过程减少。结论:我们描述了一位高度近视患者在环形屈曲手术后发展为ASI并虹膜红斑。裂隙灯检查和关节镜检查可以显示很少的虹膜红斑,但可能会误导。虹膜荧光素血管造影是评估虹膜血管异常最敏感的技术,在虹膜红斑症的早期发现中具有相当大的价值。本报告证明了虹膜荧光素血管造影在第二次玻璃体内注射贝伐单抗后虹膜红血病的快速解决。这种恢复将持续多久是未知的,如果复发,可能需要反复注射贝伐单抗。
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Anterior segment ischemia with rubeosis iridis after a circular buckling operation treated successfully with an intravitreal bevacizumab injection: a case report and review of the literature.

Purpose: To report a case of anterior segment ischemia (ASI) with rubeosis iridis after circular buckling surgery in a highly-myopic patient which was successfully treated with a second intravitreal bevacizumab injection.

Methods: Case report and review of the literature.

Discussion: ASI is a rare but potentially serious complication of posterior segment surgery. Finally it leads to neovascular glaucoma as a result of rubeosis iridis. An encircling band can compromise anterior segment circulation in different ways: by manipulation or disinsertion of the recti muscles, by occlusion of the vortex veins through compression or by changes in the blood supply of iris and ciliary body. This patient developed rubeosis iridis secondary to ASI. There was a remarkable regression of rubeosis iridis one month after a second intravitreal bevacizumab injection. Other case reports of bevacizumab use in neovascular glaucoma have shown clinical improvements of these patients, with intraocular pressure control and reduction of the neovascularization process.

Conclusion: We describe a highly-myopic patient who developed ASI with rubeosis iridis after a circular buckling operation. Slit-lamp examination and gonioscopy can show very little rubeosis iridis and can be misleading. Iris fluorescein angiography is the most sensitive technique for evaluation of iris vessel abnormalities and is of considerable value in the early detection of rubeosis iridis. This report demonstrates the rapid resolution of rubeosis iridis on iris fluorescein angiography after a second intravitreal injection of bevacizumab. How long this regression will persist is unknown and repeated injections of bevacizumab may be necessary if rubeosis reappears.

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