山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 41-47.doi: 10.6040/j.issn.1673-3770.1.2020.050

• 眼缺血综合征多学科精准诊疗 临床研究 • 上一篇    下一篇

25例虹膜新生血管发生原因探讨

李萱1,2, 黄映湘2   

  1. 李萱1, 2, 黄映湘21. 首都医科大学附属北京友谊医院 眼科, 北京 100050;
    2. 中国中医科学院眼科医院 眼底病眼外伤科, 北京 100040
  • 收稿日期:2020-05-26 出版日期:2020-07-20 发布日期:2020-08-28
  • 作者简介:李萱. 现在中国中医科学院眼科医院眼底病眼外伤科工作.
  • 基金资助:
    北京市卫生系统高层次卫生技术人才培养计划(2014-3-007)

Case analysis of 25 cases of iris neovascularizationLI Xuan1,2, HUANG Yingxiang2 1. Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 2. Department of Fundus Disease and Eye Trauma, Eye Hospital China Academy of Chinese Medicine Sciences, Beijing 100040, ChinaAbstract:

ObjectiveTo discuss the causes and appropriate treatment for iris neovascularization following the analysis of 25 cases(28 eyes). MethodsIt was a retrospective case series study involving 25 patients(28 eyes)with iris neovascularization diagnosed between September 2014 and July 2016. All the patients underwent ophthalmic examination, and all the examination findings and treatments were recorded. The causes, correlative factors, and treatment outcomes of iris neovascularization were analyzed. ResultsOf the patients, 17(20 eyes, 71.4%)had retinal ischemic signs, including vitreous hemorrhage and retinal vascularization on fundus fluorescein angiography; 8(8 eyes, 28.6%)did not have retinal ischemic signs. After 3 months of treatment, retinal vascularization resolved in all the cases, and iris neovascularization resolved completely in 20 patients(23 eyes, 82.1%), iris neovascularization was still found in 5 patients(5 eyes, 17.9%). ConclusionsAnterior segment ischemia may also lead to iris vascularization, although retinal ischemia was the main cause. Additionally, iris neovascularization may not always resolve with treatment for retinal ischemia. Finally, anti-VEGF drug injection was an effective treatment for iris neovascularization.   

  1. Key words:Glaucoma, Neovascular;
    Retinal Vascularization;
    Vascular Endothelial Growth Factors 虹膜新生血管(neovascularization of the iris, NVI)是继发于多种眼病的一种特有体征, 可以导致新生血管性青光眼(neovascular glaucoma, NVG)发生［1］。以往研究［2］认为, 视网膜缺血、缺氧, 产生血管内皮生长因子(vascular endothelial growth factors, VEGF)是导致NVI生长的原因, 主要通过全视网膜光凝术(panretinal photocoagulation, PRP), 改善视网膜缺血、消退NVI, 从而治疗或预防新生血管性青光眼。本研究对2014年9月至2016年7月期间就诊于北京友谊医院眼科的25例(28眼)发现NVI的患者, 进行回顾性研究, 探讨引起NVI生长的原因及有效的治疗方法。
  • Received:2020-05-26 Online:2020-07-20 Published:2020-08-28

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摘要： 目的 分析25例(28眼)虹膜新生血管生长原因,探讨消除虹膜新生血管的有效方法。 方法 回顾性分析2014年9月至2016年7月期间临床发现虹膜新生血管的患者25例(28眼)眼部相关检查资料,记录治疗方法及病情变化,分析虹膜新生血管发生的原因及治疗效果。 结果 25例(28眼)治疗前裂隙灯下均可见虹膜新生血管;17例(20眼,71.4%)存在视网膜缺血表现,包括FFA可见视网膜新生血管或大片非灌注区,或存在大量的玻璃体积血及纤维血管增殖膜;8例(8眼,28.6%)缺乏视网膜缺血相关表现。治疗后3个月,FFA显示25例(28眼)均未见视网膜新生血管;20例(23眼,82.1%)虹膜新生血管消退,5例(5眼,17.9%)虹膜新生血管未完全消退。 结论 眼前部缺血也是虹膜新生血管发生的原因之一;全视网膜光凝术是针对视网膜缺血的治疗手段,不能消除全部的虹膜新生血管,抗VEGF药物注射对虹膜新生血管有很好的疗效。

关键词: 青光眼,新生血管性, 视网膜新生血管化, 血管内皮生长因子

Abstract: Objective To discuss the causes and appropriate treatment for iris neovascularization following the analysis of 25 cases(28 eyes). Methods It was a retrospective case series study involving 25 patients(28 eyes)with iris neovascularization diagnosed between September 2014 and July 2016. All the patients underwent ophthalmic examination, and all the examination findings and treatments were recorded. The causes, correlative factors, and treatment outcomes of iris neovascularization were analyzed. Results Of the patients, 17(20 eyes, 71.4%)had retinal ischemic signs, including vitreous hemorrhage and retinal vascularization on fundus fluorescein angiography; 8(8 eyes, 28.6%)did not have retinal ischemic signs. After 3 months of treatment, retinal vascularization resolved in all the cases, and iris neovascularization resolved completely in 20 patients(23 eyes, 82.1%), iris neovascularization was still found in 5 patients(5 eyes, 17.9%). Conclusions Anterior segment ischemia may also lead to iris vascularization, although retinal ischemia was the main cause. Additionally, iris neovascularization may not always resolve with treatment for retinal ischemia. Finally, anti-VEGF drug injection was an effective treatment for iris neovascularization.

Key words: Glaucoma, Neovascular, Retinal Vascularization, Vascular Endothelial Growth Factors

中图分类号: 

  • R773.1
[1] Shazly TA, Latina MA. Neovascular glaucoma: etiology, diagnosis and prognosis[J]. Semin Ophthalmol, 2009, 24(2):113-121. doi: 10.1080/08820530902800801.
[2] 中华医学会眼科学分会青光眼学组. 中国新生血管性青光眼诊疗专家共识(2019年)[J]. 中华眼科杂志, 2019, 55(11):814-817. doi:10.3760/cma.j.issn.0412-4081.2019.11.005.
[3] Liao N, Li CH, Jiang H, et al. Neovascular Glaucoma: a retrospective review from a tertiary center in China[J]. BMC Ophthalmol, 2016, 16: 14. doi:10.1186/s12886-016-0190-8.
[4] 杨秀芬, 李红阳, 赵露,等. 眼缺血综合征的临床及影像学特点分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4):119-123. doi:10.6040/j.issn.1673-3770.0.2018.526. YANG Xiufen, LI Hongyang, ZHAO Lu, et al. Clinical and imaging characteristics in patients with ocular ischemic syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4):119-123. doi:10.6040/j.issn.1673-3770.0.2018.526.
[5] Barac IR, Pop MD, Gheorghe AI, et al. Neovascular secondary Glaucoma, etiology and pathogenesis[J]. Rom J Ophthalmol, 2015, 59(1): 24-28. PMID: 27373111 PMCID: PMC5729807.
[6] 刘朝辉, 高晓虹. 血管内皮生长因子及其受体的研究进展[J]. 中国药物与临床, 2017, 17(8): 1162-1164. doi:10.11655/zgywylc2017.08.023.
[7] 赵世红, 何守志. 血管内皮生长因子及其受体与眼内新生血管性疾病[J]. 眼科研究, 2003, 21(1):103-106. doi: 10.3760/cma.j.issn.2095-0160.2003.01.035. Zhao Shihong. Vascular endothelial growth factor and its receptor in the disease related with intraocular neovascularization[J]. CHINESE OPHTHALMIC RESEARCH, 2003, 21(1):103-106. doi: 10.3760/cma.j.issn.2095-0160.2003.01.035.
[8] Rong AJ, Swaminathan SS, Vanner EA, et al. Predictors of neovascular Glaucoma in central retinal vein occlusion[J]. Am J Ophthalmol, 2019, 205: 201-202. doi:10.1016/j.ajo.2019.04.029.
[9] Sun C, Zhang HS, Jiang JJ, et al. Angiogenic and inflammatory biomarker levels in aqueous humor and vitreous of neovascular Glaucoma and proliferative diabetic retinopathy[J]. Int Ophthalmol, 2020, 40(2): 467-475. doi:10.1007/s10792-019-01207-4.
[10] Shi LK, Yang J, Lin JY. What is the impact of intravitreal injection of conbercept on neovascular Glaucoma patients: a prospective, interventional case series study[J]. BMC Ophthalmol, 2019, 19(1): 128. doi:10.1186/s12886-019-1138-6.
[11] 祝敏燕, 韩丽荣, 沈茜. 增殖型糖尿病性视网膜病变血浆、房水、玻璃体VEGF含量分析[J]. 第二军医大学学报, 2004, 25(11): 1250. doi: 10.3321/j.issn:0258-879X.2004.11.043. ZHU Minyan, HAN Lirong, SHEN Qian. Analysis of vascular endothelial growth factor concentration in plasma, aqueous humor and vitreous body with proliferative diabetic retinopathy[J]. Academic Journal of Second Military Medical University, 2004, 25(11): 1250. doi: 10.3321/j.issn:0258-879X.2004.11.043.
[12] Ma N, Hunt NH, Madigan MC, et al. Correlation between enhanced vascular permeability, up-regulation of cellular adhesion molecules and monocyte adhesion to the endothelium in the Retina during the development of fatal murine cerebral malaria[J]. Am J Pathol, 1996, 149(5): 1745-1762.
[13] 汪枫桦, 张鹏飞, 孙晓东. 抗血管内皮生长因子治疗不应忽视激光的作用[J]. 中华眼科杂志, 2015, 51(12):885-887. doi: 10.3760/cma.j.issn.0412-4081.2015.12.002. Wang Fenghua, Zhang Pengfei, Sun Xiaodong. The role of laser photocoagulation in the anti-vascular endothelial growth factor therapy era[J]. Chinese Journal of Ophthalmology, 2015, 51(12):885-887. doi: 10.3760/cma.j.issn.0412-4081.2015.12.002.
[14] Havens SJ, Gulati V. Neovascular Glaucoma[M] //Developments in Ophthalmology. S. Karger AG, 2016, 55: 196-204.
[15] 曾苗, 陈晓, 宋艳萍, 等. 视网膜中央静脉阻塞患眼光相干断层扫描血管成像与荧光素眼底血管造影检查结果对比分析[J]. 中华眼底病杂志, 2016, 32(4):362-366. doi: 10.3760/cma.j.issn.1005-1015.2016.04.005. Zeng Miao, Chen Xiao, Song Yanping. Consistency analysis of optical coherence tomography angiography and fundus fluorescein angiography in the diagnosis of central retinal vein occlusion[J]. Chinese Journal of Ocular Fundus Diseases, 2016, 32(4):362-366. doi: 10.3760/cma.j.issn.1005-1015.2016.04.005.
[16] Lois N, Forrester JV. Fundus Autofluorescence, 2nd edition[M]. Wolters Kluwer Health/ Lippincott Williams & Wilkins, 2015: 432-444,451-459.
[17] Sugimoto Y, Mochizuki H, Okumichi H, et al. Effect of intravitreal bevacizumab on iris vessels in neovascular glaucoma patients[J]. Albrecht Von Graefes Arch Fur Klinische Und Exp Ophthalmol, 2010, 248(11): 1601-1609. doi:10.1007/s00417-010-1406-x.
[18] Malhotra R, Gregory-Evans K. Management of ocular ischaemic syndrome[J]. Br J Ophthalmol, 2000, 84(12): 1428-1431. doi:10.1136/bjo.84.12.1428.
[19] Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of diabetic retinopathy study(DRS)findings, DRS report number 8. the diabetic retinopathy study research group[J]. Ophthalmology, 1981, 88(7): 583-600.
[20] Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome[J]. Ophthalmology, 1997, 104(5): 859-864. doi:10.1016/s0161-6420(97)30221-8.
[21] 夏沁韵, 陈震, 邢怡桥. 新生血管性青光眼治疗进展[J]. 国际眼科杂志, 2020, 20(6):987-989. doi: 10.3980/j.issn.1672-5123.2020.6.13. XIA Qinyun, CHEN Zhen, XING Yiqiao A great progress in the treatment of neovascular glaucoma[J]. International Eye Science, 2020, 20(6):987-989. doi: 10.3980/j.issn.1672-5123.2020.6.13.
[22] Ha JY, Lee TH, Sung MS, et al. Efficacy and safety of intracameral bevacizumab for treatment of neovascular Glaucoma[J]. Korean J Ophthalmol, 2017, 31(6): 538-547. doi:10.3341/kjo.2017.0017.
[23] Karpilova MA, Durzhinskaya MH. Anti-VEGF drugs in the treatment of neovascular Glaucoma[J]. Vestn Oftalmol, 2019, 135(5. Vyp. 2): 299-304. doi:10.17116/oftalma2019135052299.
[24] Simha A, Aziz K, Braganza A, et al. Anti-vascular endothelial growth factor for neovascular Glaucoma[J]. Cochrane Database Syst Rev, 2020, 2: CD007920. doi:10.1002/14651858.CD007920.pub3.
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