Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy
Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy
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DOI：
10.1007/s00417-008-0914-4
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发表时间：
2008-12-01
影响因子：
2.7
通讯作者：
Azarmina, Mohsen
中科院分区：
文献类型：
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作者：
Moradian, Siamak;Ahmadieh, Hamid;Azarmina, Mohsen
增殖性糖尿病视网膜病变(PDR)患者玻璃体中血管内皮生长因子(VEGF)浓度显著升高。贝伐单抗(阿瓦斯丁)是一种人源化的抗血管内皮生长因子的单抗。玻璃体内注射贝伐单抗(IVB)最近被证明对包括PDR在内的一些眼部新生血管是有效的。在这项研究中，我们评估了IVB在活动期和进展性PDR患者中的疗效。在一项干预性的前瞻性病例系列中，活动期和进展性PDR患者的眼睛每隔6周或12周接受一到三次IVB注射(1.25 mg)。在第一次注射后1周、6周、12周和20周进行完整的眼科检查和彩色眼底照相。分别于注射前和注射后20周进行荧光素血管造影(FA)检查。主要观察指标为玻璃体出血(VH)清除和活动性纤维血管组织(FVT)消退。次要结果是最佳矫正视力(BCVA)的任何变化和任何不良事件的发生率。研究包括38名患者的38只眼，平均年龄为54.7+/-10.1岁。VH在1周(P=0.014)、12周(P=0.0001)和20周(P=0.002)后显著改善。FVT的血管成分消退，但FVT面积无变化。在所有后续检查中，与基线相比，平均BCVA有显著改善。2例中度纤维组织增生的患者发展为牵引性视网膜脱离(TRD)。IVB对活动性、进展性PDR有显著的治疗效果：该治疗导致显著的VH消退和新生血管消退。同时，这种手术可能会增加纤维性增生症患者患TRD的风险。
Vitreous concentration of vascular endothelial growth factor (VEGF) rises significantly during proliferative diabetic retinopathy (PDR). Bevacizumab (Avastin) is a humanized monoclonal antibody to VEGF. Intravitreal administration of bevacizumab (IVB) has recently been shown to be effective in some ocular neovascularizations, including PDR. In this study we evaluate the efficacy of IVB in eyes with active, progressive PDR.In an interventional prospective case series, eyes with active, progressive PDR underwent one to three IVB injections (1.25 mg) at intervals of either 6 or 12 weeks. Complete ophthalmic examinations and color fundus photography were performed at baseline and 1, 6, 12, and 20 weeks after the first injection. Fluorescein angiography (FA) was performed before injection and 20 weeks after. The primary outcome measures were clearing of vitreous hemorrhage (VH) and regression of active fibrovascular tissue (FVT). The secondary outcomes were any change in best-corrected visual acuity (BCVA) and any incidence of adverse events.Thirty eight eyes of 38 patients with a mean age of 54.7 +/- 10.1 years were included in the study. VH resolved significantly after 1 week (P=0.014), 12 weeks (P=0.0001), and 20 weeks (P=0.002). The vascular component of FVT regressed, though the FVT area did not change. Mean BCVA improved significantly compared to baseline at all follow-up examinations. Two cases showing moderate fibrous proliferation developed traction retinal detachment (TRD).IVB has significant therapeutic effect on eyes with active, progressive PDR: the treatment causes a significant amount of VH resolution and neovessel regression. At the same time, this procedure may increase the risk of TRD in eyes with fibrous proliferation.