Rubeóza dúhovky je vážna komplikácia, ktorá sa najčastejšie vyskytuje pri diabetickej retinopátii a oklúzii retinálnych ciev. Za novotvorbu ciev sú zodpovedné cytokíny, hlavne vaskulárny rastový faktor (VEGF). Liečba, ktorá inhibuje efekt VEGF, predstavuje nové možnosti v liečbe neovaskulárnych ochorení. Bevacizumab (Avastin) je anti-VEGF protilátka, ktorá blokuje všetky formy VEGF-A. U 3 očí s proliferatívnou diabetickou retinopatiou a neovaskularizáciou dúhovky a komorového uhla sme podali intravitrálne 1,25 mg Avastinu. Už za týždeň po podaní lieku bolo na fluoroangiografii viditeľné zníženie presakovania dúhovky a úplne vymiznutie neovaskularizácie za 3 týždne. Na jednom oku po 3 mesiacoch nastal relaps neovaskularizácie a liečbu sme museli opakovať. Pri kontrole 9 mesiacov po druhej aplikácii je stav stabilizovaný, bez neovaskularizácie. U dvoch očí pred podaním Avastinu bol zvýšený aj vnútroočný tlak, ktorý nereagoval na liečbu. Po vymiznutí neovaskularizácie sa vnútročný tlak upravil a antiglaukomatózna liečba mohla byť vysadená. Liečba bevacizumabom do sklovca u neovaskularizácie dúhovky a komorového uhla sa ukázala ako účinná, došlo k vymiznutiu neovaskularizácie a úprave vnútroočného tlaku. Ani u jedného pacienta po podaní bevacizumabu nedošlo k žiadnym nežiadúcim účinkom.

The rubeosis of the iris is a serious complication especially in diabetic retinopathy and retinal veins occlusion. Cytokines, especially the vascular growing factor (VEGF), are responsible for the forming of new vessels. The treatment that inhibits the effect of the VEGF presents new possibilities in the neovascular diseases treatment. Bevacizumab (Avastin) is an anti-VEGF antibody that blocks all forms of VEGF-A. In three eyes with proliferative diabetic retinopathy and neovascularization of the iris and the anterior chamber angle, the dose of 1.25 mg of Avastin was applied intravitrealy. Just one week after the application of the drug, the decrease of the leakage on the iris, and the total disappearance of the neovascularization in three weeks were visible on the fluorescein angiogram. The recurrence of the neovascularization was found in one eye after three months and the treatment had to be repeated. Nine months after the second application, the disease is stabilized without the neovascularization. The intraocular pressure was elevated in two eyes before the application of Avastin, and was refractive to the treatment. After the disappearance of the neovascularization, the intraocular pressure was normalized and it was possible to terminate the antiglaucomatous therapy. The bevacizumab intravitreal treatment of the neovascularization of the iris and the anterior chamber angle was proved to be efficient, the neovascularization disappeared and the intraocular pressure was normalized. There were no side effects after the bevacizumab applications in any of our patients.

AKH Linz

Treatment of the rubeosis of the iris and the neovascular glaucoma in proliferative diabetic retinopathy by means of anti-VEGF

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