신생혈관녹내장 환자에 앞방내 Bevacizumab 주사 후 혈관내피성장인자의 방수내 농도변화

Abstract

목적 신생혈관녹내장환자에게 앞방내 bevacizumab 주사를 시행한 전후의 방수내 혈관내피성장인자의 농도를 비교하고 bevacizumab의 앞방내 주사로 인한 각막내피세포의 손상여부를 알아보고자 하였다. 대상과 방법 5명 5안의신생혈관녹내장환자에게 앞방내 bevacizumab주사를 1.25mg(0.05ml) 시행하였다. 방수는 주사 직전과 주사 2주 후 채취하였다. 대조군으로 신생혈관녹내장이 없는 정상 환자 8명에게서 백내장수술 직전 방수를 채취하였다. 방수내 혈관내피성장인자의 농도는 enzyme-linked immunosorbent assay법을 사용하여 측정하였다. 각막내피세포손상을 조사하기 위해 경면현미경을 주사직전과 주사후 2주에 시행하였다. 그리고 세극등 검사와 홍채신생혈관의 감소여부를 보기 위해 홍채 형광혈관촬영을 시행하였다. 결과 bevacizumab주사 후 홍채신생혈관의 소실과 형광누출의 감소가 모든 대상안에서 관찰되었다. 주사직전 방수내 혈관내피성장인자의 농도는 1181.8±1248.3 pg/mL (46.0 to 2745.7 pg/mL) 이었고 주사 후 2주째에는 33.2±12.2 pg/mL(14.0 to 43.78pg/mL) (P=0.04, Wilcoxon signed rank test)로 감소하였다. 안압과 각막내피세포에는 주사 전후에 통계적으로 유의한 차이를 보이지 않았다. 결론 앞방내 bevacizumab주사는 신생혈관녹내장환자의 홍채혈관신생을 현격하게 감소시킬 수 있었다. 방수내 VEGF는 주사 2주 후 유의한 수준으로 감소하였고 주사에 의한 각막내피세포독성은 관찰되지 않았다.; Purpose To study the concentration of vascular endothelial growth factor in the aqueous humor before and after intracameral injection of bevacizumab in eyes with neovascular glaucoma and to detect the duration of anti-VEGF effect of bevacizumab in anterior chamber. Methods In this prospective, interventional case series, 1.25 mg (0.05cc) of bevacizumab was injected into the anterior chamber of 5 eyes in 5 neovascular glaucoma patients. Aqueous humor samples were obtained just before intracameral injection of bevacizumab and 2 weeks after the injection. As a control group aqueous humor samples also were obtained in 8 eyes of 8 patients with cataract without neovascular glaucoma. The vascular endothelial growth factor concentration in the aqueous humor was measured using an enzyme-linked immunosorbent assay. To investigate the corneal endothelial damage after intrecameral bevacizumab injection, specular microscopy was done before injection and 2 weeks after injection. Also, slit lamp photo and iris fluorescent angiography was taken to determine the regression of iris neovascularization. Results After injection, substantial regression of neovascularization or fluorescein leakage was seen in eyes of all subjects. The VEGF concentrations in the aqueous humor in eyes with NVG was 1181.8±1248.3 pg/mL (46.0 to 2745.7 pg/mL) before intracameral injection of bevacizumab. two weeks after injection, the VEGF concentration decreased to 33.2±12.2 pg/mL(14.0 to 43.78pg/mL) (P-=0.04, Wilcoxon signed rank test) . There were no significant change in IOP and corneal endothelial cells. Conclusions Intracameral bevacizumab injection could remarkably reduce the iris neovascularization of neovascular glaucoma patient. The VEGF level was significantly decreased two weeks after injection and conreal toxicity was not observed in short term follow up periods.