Therapie des rubeotischen Sekundärglaukoms IOD-Verlauf nach Kombinationstherapie bestehend aus Zyklophotokoagulation (CPC), Kryokoagulation und intravitrealer Bevacizumab-Injektion

Zusammenfassung

Hintergrund: Das rubeotische Sekundärglaukom bleibt ein therapeutisches Problem. In den letzten Jahren wurde vermehrt der Erfolg von Avastin® in Kombination mit CPC und/oder Laserkoagulation diskutiert.

Methode: Bei 23 Patienten, die bei dekompensiertem rubeotischen Sekundärglaukom eine Dreifachtherapie aus äquatorialer Kryokoagulation, Zyklophotokoagulation und intravitrealer Bevacizumab-Injektion erhalten haben, wurde retrospektiv der Druckverlauf direkt postoperativ und nach 4–19 Monaten untersucht.

Ergebnisse: Es konnte eine durchschnittliche IOD-Senkung von 19,7 mmHg (55,1 %) bis zur Entlassung und nach 10,4 Monaten um 17,4 mmHg (48,7 %) bei einem durchschnittlichen Ausgangs-IOD von 35,7 mmHg verzeichnet werden. Die lokalen Glaukomtherapeutika haben sich mit 2,1 Wirkstoffen bei Aufnahme und 1,9 bei Entlassung nicht relevant verringert, die systemische Diamoxgabe konnte von 12 Patienten bei Aufnahme auf 2 Patienten bei Entlassung gesenkt werden. Bei 21 Patienten (91,3 %) konnten die IOD-Werte langfristig in den normotonen Bereich (10–21 mmHg) gesenkt werden, bei den übrigen 2 Patienten (8,7 %) lag Schmerzfreiheit vor.

Schlussfolgerung: Es zeigte sich eine gute kurz- und langfristige Drucksenkung ohne Auftreten von vermehrten Komplikationen, sodass wir die Kombinationstherapie als Behandlung des rubeotischen Sekundärglaukoms bei Augen mit deutlich reduziertem Visus als geeignet ansehen.

Abstract

Background: Intravitreal Bevacizumab has been used as adjunct treatment to diode laser cyclophotocoagulation and/or retinal photo-/cryocoagulation in eyes with neovascular glaucoma and is discussed to reduce intraocular pressure and rubeosis irides in addition.

Methods: This study investigated the drop of the intraocular pressure of 23 patients who were treated by a concomitant therapy consisting of retinal kryocoagulation, diode laser coagulation and intravitreal injection of Avastin® administered in one session.

Results: At the time of discharge patients exhibited a 55.1 % (19.7 mmHg) decrease in intraocular pressure and also a 48.7 % (17.4 mmHg) decrease in regard to follow-up results. Topical agents were not significantly decreased with 2.1 agents at the beginning of treatment and 1.9 at the time of discharge. Furthermore, the systemic administration of acetazolamide was reduced from 12 patients at the beginning to 2 patients at the time of discharge. In 21 cases the intraocular pressure returned to normal levels, whereas the other two patients were pain-free after treatment.

Conclusion: With the administration of triple therapy, the intraocular pressure showed a significant reduction. There were no severe complications and the symptoms also were improved significantly.

Schlüsselwörter

Avastin - CPC - Kryotherapie - Neovaskularisationsglaukom

Key words

Avastin - diode laser coagulation - cryotherapy - neovascular glaucoma

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