Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy
Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy
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DOI：
10.1136/bjo.2007.127142
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发表时间：
2008-02-01
影响因子：
4.1
通讯作者：
Sanchez, J. G.
中科院分区：
文献类型：
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作者：
Arevalo, J. F.;Maia, M.;Sanchez, J. G.
目的：本研究的目的是报告玻璃体内注射贝伐单抗（Avastin）后牵引性视网膜脱离（TRD）的发展或进展，贝伐单抗（Avastin）用作玻璃体切除术的辅助治疗严重增殖性糖尿病视网膜病变（PDR）。在玻璃体切除术前玻璃体内注射1.25 mg贝伐珠单抗后发生TRD或进展的患者的临床图表，结果：211例玻璃体内注射中有11例（5.2%）发生TRD或进展。所有患眼均患有全视网膜光凝（PRP）难治性PDR。9例患者患有1型糖尿病（DM），2例患者患有2型DM。患者的平均年龄为39.5岁（范围22 - 62岁）。在本研究中，所有患者均使用胰岛素给药，血糖控制较差（平均HbA（1c）10.6%）。从注射到TRD的时间平均为13天（范围3 - 31天）。TRD发展或进展时的平均最佳矫正视力（BCVA）为最小分辨角（LogMAR）的对数2.2（范围1.0 - 2.6）（平均Snellen等效手部运动;范围20/200至光感），与基线BCVA相比统计学显著恶化（p < 0.0001）。8眼接受玻璃体切除术，3例患者拒绝或无法接受手术。手术后的最终平均BCVA为LogMAR 0.9（范围0.2 - 2.0）（平均Snellen相当于20/160;范围20/32到数手指），与TRD BCVA相比有统计学显著改善（p=0.002）。
Aims: The aim of this study was to report the development or progression of tractional retinal detachment (TRD) after the injection of intravitreal bevacizumab (Avastin) used as an adjuvant to vitrectomy for the management of severe proliferative diabetic retinopathy (PDR).Methods: The clinical charts of patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 mg bevacizumab before vitrectomy for the management of PDR were reviewed.Results: Eleven eyes (patients) out of 211 intravitreal injections (5.2%) that developed or had progression of TRD were identified. All eyes had PDR refractory to panretinal photocoagulation (PRP). Nine patients had type 1 diabetes mellitus (DM), and two patients had type 2 DM. Patients had a mean age of 39.5 years (range 22 - 62 years). In the current study, all patients used insulin administration and had poor glycaemic control (mean HbA(1c) 10.6%). Time from injection to TRD was a mean of 13 days (range 3 - 31 days). Mean best correct visual acuity (BCVA) at TRD development or progression was logarithm of the minimal angle of resolution (LogMAR) 2.2 (range 1.0 - 2.6) (mean Snellen equivalent hand motions; range 20/200 to light perception), a statistically significant worsening compared with baseline BCVA (p < 0.0001). Eight eyes underwent vitrectomy and three patients refused or were unable to undergo surgery. The final mean BCVA after surgery was LogMAR 0.9 (range 0.2 - 2.0) (mean Snellen equivalent 20/160; range 20/32 to counting fingers), a statistically significant improvement compared with TRD BCVA (p=0.002).Conclusions: TRD may occur or progress shortly following administration of intravitreal bevacizumab in patients with severe PDR.