PROSPECTIVE STUDY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE VERSUS BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION
PROSPECTIVE STUDY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE VERSUS BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION
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DOI：
10.1097/iae.0b013e3181f4420d
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发表时间：
2011-05-01
影响因子：
3.3
通讯作者：
Tang, Shibo
中科院分区：
文献类型：
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作者：
Ding, Xiaoyan;Li, Jiaqing;Tang, Shibo
目的：比较玻璃体内注射曲安奈德（IVT）与玻璃体内注射贝伐单抗（IVB）治疗视网膜中央静脉阻塞继发黄斑水肿（ME）的疗效和安全性。共31例（32只眼）ME伴视网膜中央静脉阻塞患者随机分为2组。其中16眼玻璃体腔注射无炎性物质曲安奈德4 mg/0.1mL，16眼静脉注射维生素B1.25mg/0.05mL。如果患者在首次治疗后3个月通过光学相干断层扫描确定患有ME或Snellen视力表中视力丧失至少2行，则给予额外注射。在9个月的随访期间，记录最佳矫正视力、裂隙灯生物显微镜检查、眼压、荧光素眼底血管造影、光学相干断层扫描、所需注射次数和不良事件。IVT和IVB组在注射后2周和1、3、6和9个月的最佳矫正视力均显著提高，但在9个月的随访期间，两个治疗组之间没有发现统计学差异。各治疗组在注射后1、3、6、9个月平均黄斑中心厚度均下降，随访期间任何时间两组间均无统计学差异（P > 0.05）。与接受IVB治疗的患者相比，接受IVT治疗的患者在第2周时视力恢复更快，中央黄斑厚度改善。IVT组16只眼中的5只眼和IVB组16只眼中的12只眼由于ME复发或未解决的视网膜内或视网膜下液体而需要重复注射。IVT组的平均治疗次数为1.31 +/- 0.48，而IVB组为2.38 +/- 1.04。仅在IVT组中发现了显著的眼内压升高，6例患者接受了局部眼内压降低药物治疗，1例患者需要小梁切除术。IVT组2例发生黄斑前膜。结论：IVT和IVB治疗继发于视网膜中央静脉阻塞的ME的有效性和安全性是一项前瞻性的干预研究。IVT和IVB治疗均能有效提高继发于视网膜中央静脉阻塞的ME患者的最佳矫正视力，降低黄斑中心厚度，且无全身副作用;两个治疗组之间的最佳矫正视力或平均黄斑中心厚度测量值均无统计学差异。曲安奈德和贝伐单抗的效果都不是永久性的，IVT组的注射次数较少。然而，曲安奈德比贝伐单抗引起更多的不良事件。视网膜31：838-845，2011年
Purpose: To compare the efficacy and safety of intravitreal triamcinolone acetonide (IVT) versus intravitreal bevacizumab (IVB) for the treatment of macular edema (ME) secondary to central retinal vein occlusion.Methods: Prospective, consecutive, clinical interventional study. A total of 31 consecutive patients (32 eyes) with ME associated with central retinal vein occlusion were randomized to 2 groups. Sixteen eyes were treated with intravitreal injection of 4 mg/0.1 mL preservative-free triamcinolone acetonide; 16 eyes received IVB 1.25mg/0.05 mL. Patients were given additional injections if they had ME as determined by optical coherence tomography 3 months after the first treatment or visual acuity loss of at least 2 lines in a Snellen chart. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, fundus fluorescein angiography, optical coherence tomography, the number of required injections, and adverse events were recorded during the 9-month follow-up period.Results: Best-corrected visual acuity was significantly improved at 2 weeks and 1, 3, 6, and 9 months after injection in both the IVT and IVB groups, but no statistical difference was found between the 2 treatment groups during the 9-month follow-up period. The mean central macular thickness decreased at 1, 3, 6, and 9 months after injection within each treatment group, and no statistical difference was found between the 2 treatment groups at any time during the follow-up period (P > 0.05). Patients who received IVT treatment appeared to have quicker visual recovery and improved central macular thickness at Week 2 compared with those who received IVB treatment. Five of 16 eyes in the IVT group and 12 of 16 eyes in the IVB group required a repeated injection because of recurrent ME or unresolved intraretinal or subretinal fluid. The mean number of treatment was 1.31 +/- 0.48 in the IVT group, as compared with 2.38 +/- 1.04 in the IVB group. Significant intraocular pressure increase was found only in the IVT group, and six patients received topical intraocular pressure lowering medication, and one patient required trabeculectomy. Premacular membranes were developed in 2 patients in the IVT group.Conclusion: This is a prospective interventional study evaluating the efficacy and safety outcomes of IVT and IVB treatment for ME secondary to central retinal vein occlusion. Both IVT and IVB treatments can effectively improve best-corrected visual acuity and reduce central macular thickness in patients with ME secondary to central retinal vein occlusion without systemic side effects; no statistical differences were found in either best-corrected visual acuity or mean central macular thickness measurement between the two treatment groups. Both the effect of triamcinolone acetonide and that of bevacizumab were not permanent, and less injections were performed in the IVT group. However, triamcinolone acetonide causes more adverse events than bevacizumab. RETINA 31:838-845, 2011