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目的:探讨玻璃体腔内注射bevacizumab (Avastin)联合白内障手术预防脉络膜新生血管(choroidal neovascularization,CNV)的再次激活及年龄相关性黄斑变性(age-relatedmacular degeneration, AMD)。方法:对12例接受湿性年龄相关变性治疗的白内障患者给予透明角膜切口白内障超声乳化和人工晶状体植入手术,最后予以玻璃体腔内注射1.25mg bevacizumab (0.05mL)。主要评价指标:视力恢复、脉络膜新生血管的再次激活,及相干光断层成相术(OCT)对渗漏液体的评估。结果:患者最佳矫正视力(best-corrected visual acuity, BCVA)术后显著提高(脉络膜新生血管闭合后P<0.01,白内障发生后P=0.049,t检验)。白内障术后平均随访时间为11.8mo(标准差6.1,范围3 ～22mo),随访期内患者未出现脉络膜新生血管的再次激活及新的脉络膜新生血管病变。结论:在给予脉络膜新生血管及年龄相关性黄斑变性治疗的患者,白内障手术联合玻璃体腔内注射bevacizumab可预防脉络膜新生血管的再次激活。
Objective: To investigate the intravitreal bevacizumab (Avastin) combined with cataract surgery to prevent the reactivation of choroidal neovascularization (CNV) and age-related macular degeneration (AMD). Methods: Twelve patients with cataract treated by wet age-related degeneration were treated with clear corneal incision phacoemulsification and intraocular lens implantation. Finally, intravitreal injection of 1.25 mg bevacizumab (0.05 mL) was performed. MAIN OUTCOME MEASURES: Visual acuity restoration, reactivation of choroidal neovascularization, and assessment of fluid leakage by coherent light tomography (OCT). RESULTS: The best-corrected visual acuity (BCVA) was significantly improved (P <0.01 after choroidal neovascularization and P = 0.049, t-test after cataract). The mean follow-up time after cataract surgery was 11.8 months (standard deviation 6.1, range 3 to 22 months). There was no reactivation of choroidal neovascularization and new choroidal neovascularization in the follow-up period. CONCLUSIONS: Cataract surgery combined with intravitreal bevacizumab may prevent the reactivation of choroidal neovascularization in patients treated with choroidal neovascularization and age-related macular degeneration.