Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema
Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema
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DOI：
10.1097/iae.0b013e318176de48
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发表时间：
2008-09-01
影响因子：
3.3
通讯作者：
Haritoglou, Christos
中科院分区：
文献类型：
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作者：
Kook, Daniel;Wolf, Atmin;Haritoglou, Christos
目的：评价贝伐单抗治疗慢性弥漫性糖尿病黄斑水肿的远期疗效。方法：将126例慢性弥漫性糖尿病黄斑水肿患者(平均年龄：66岁)纳入前瞻性非对照病例系列。纳入试验独立于水肿大小、视网膜厚度、视力(VA)、年龄、代谢控制、糖尿病类型或既往治疗类型。患者接受了全面的眼科检查，包括ETDRS最佳矫正视力、裂隙灯检查、眼压测量、黄斑立体生物显微镜、光学相干断层扫描(OCT)测量视网膜厚度、荧光素血管造影术和眼底照相。所有患者均接受反复玻璃体内注射贝伐单抗(1.25 mg)治疗。结果：所有患者均接受过激光治疗(62%的局部激光治疗，38%的全视网膜激光治疗)，玻璃体切割术(11%)或玻璃体内注射曲安奈德(41%)。所有患者都完成了6个月，59名患者(47%)完成了12个月的随访；在此期间，48%的患者至少接受了三次贝伐单抗玻璃体内注射。黄斑中心凹无血管区平均直径为858+/-341µm，基线时平均视力为40.3个ETIDRS字母(0.82logMAR Snellen VA)，OCT时平均中央视网膜厚度为463个µm，术后6个月平均变化-1.6个ETDRS字母，12个月后变化显著(+5.1个ETDRS字母)。平均中央视网膜厚度(OCT)6个月后降至374µm(P<；0.001)，12个月后降至357µm(P<；0.001)。视网膜厚度的变化与视力无相关性。没有调查的其他因素，如年龄、视网膜中央厚度或既往治疗，都不能预测VA的变化。结论：即使在慢性弥漫性缺血型糖尿病黄斑水肿的患者中，反复玻璃体内注射贝伐单抗也可以观察到视网膜中央厚度的长期减少。在这些患者中，视网膜厚度的平均减少与平均视力的增加是一致的。在没有缺血的糖尿病黄斑水肿的早期阶段使用贝伐单抗治疗可能会有更好的功能结果。
Purpose: To evaluate the long-term efficacy of bevacizumab for the treatment of chronic diffuse diabetic macular edema after various previous treatments.Methods: A total of 126 patients (mean age: 66 years) with chronic diffuse diabetic macular edema were consecutively incorporated in this prospective, noncomparative case series. Inclusion was performed independently from the size of edema, retinal thickness, visual acuity (VA), age, metabolic control, type of diabetes, or type of previous treatments. The patients underwent a complete eye examination including best-corrected VA with ETDRS charts, slit lamp examination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, retinal thickness measurement using optical coherence tomography (OCT), fluorescein angiography, and fundus photography. All patients were treated with repeated intravitreal injections of bevacizumab (1.25 mg). Patients were observed in intervals of 4-12 weeks for a period of up to 6-12 months.Results: All patients had received various previous treatments such as laser treatment (62% focal laser treatment, 38% panretinal laser treatment), vitrectomy (11 %), or intravitreal injection of triamcinolone (41 %). All patients completed 6 months and 59 patients (47%) completed 12 months of follow-up; within this period 48% had received at least three intravitreal injections of bevacizumab. Mean diameter of foveal avascular zone was 858 +/- 341 mu m. At baseline mean VA was 40.3 ETIDRS letters (0.82 logMAR Snellen VA) and mean central retinal thickness on OCT was 463 mu m. Throughout follow-up VA changes were not significant with a mean change of -1.6 ETDRS letters after 6 months, but significant with +5.1 ETDRS letters after 12 months. Mean central retinal thickness (OCT) decreased to 374 mu m after 6 months (P < 0.001) and to 357 mu m after 12 months (P < 0.001). Changes of retinal thickness and visual acuity did not correlate. No other factors investigated, such as age, central retinal thickness, or previous treatments, were predictive for a change of VA. Macular ischemia was not exacerbated as a result of the treatment.Conclusion: Even in cases with chronic diffuse ischemic diabetic macular edema, a long-term decrease of central retinal thickness can be observed following repeated intravitreal injections of bevacizumab. In these patients, mean decrease in retinal thickness is aligned with a gain in mean VA. Treatment with bevacizumab at an earlier stage of diabetic macular edema without ischemia may be associated with an even better functional outcome.