Preoperative Intravitreal Bevacizumab Use as an Adjuvant to Diabetic Vitrectomy: Histopathologic Findings and Clinical Implications
Preoperative Intravitreal Bevacizumab Use as an Adjuvant to Diabetic Vitrectomy: Histopathologic Findings and Clinical Implications
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DOI：
10.1016/j.ophtha.2010.08.038
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发表时间：
2011-04-01
期刊：
影响因子：
13.7
通讯作者：
Selim, Abdulhafez A.
中科院分区：
文献类型：
--
作者：
El-Sabagh, Hazem A.;Abdelghaffar, Walid;Selim, Abdulhafez A.
目的：评估术前玻璃体内注射贝伐单抗（IVB）和手术之间的间隔对去除的糖尿病纤维血管增生膜成分的影响。设计：干预性、连续性、前瞻性、比较性病例系列。参与者：49例活动性糖尿病纤维血管增生伴并发症需要玻璃体切除术的患者，共52只眼。方法：将接受IVB的参与者眼睛分为8组，其中在注射后第1、3、5、7、10、15、20和30天进行玻璃体视网膜手术。一组具有相同诊断和手术干预但未注射IVB的患眼用于比较。所有患眼均行玻璃体切除术，取增生膜标本行苏木精-伊红染色、免疫组化染色、组织病理学检查主要观察指标：比较分析不同成分的纤维血管增生情况（CD 34、平滑肌肌动蛋白和胶原蛋白）。从注射后第5天开始，泛内皮标志物CD 34表达水平显著低于对照组（P < 0.001），在注射后30天或之后取出的所有标本中具有最小表达（1+）。对照眼在第1天几乎未检测到平滑肌肌动蛋白的阳性染色，在第15天及以后始终强烈（P < 0.001）。与对照眼相比，三色染色的表达水平在第10天显著升高（P < 0.001），并在随后的手术时间点继续增加。在IVB后糖尿病纤维血管增殖中观察到促纤维化转换，并且我们的结果表明在IVB后约10天，增殖的血管成分显著减少，而收缩成分（平滑肌肌动蛋白和胶原蛋白）还不丰富。财务披露：作者对本文中讨论的任何材料没有专有或商业利益。Ophthalmology 2011;118：636-641（C）2011，美国眼科学会。
Purpose: To evaluate the effects of intervals between preoperative intravitreal injection of bevacizumab (IVB) and surgery on the components of removed diabetic fibrovascular proliferative membranes.Design: Interventional, consecutive, prospective, comparative case series.Participants: A total of 52 eyes of 49 patients with active diabetic fibrovascular proliferation with complications necessitating vitrectomy.Methods: Participant eyes that had IVB were divided into 8 groups in which vitreoretinal surgery was performed at days 1, 3, 5, 7, 10, 15, 20, and 30 postinjection. A group of eyes with the same diagnosis and surgical intervention without IVB injection was used for comparison. In all eyes, proliferative membrane specimens obtained during vitrectomy were sent for histopathologic examination using hematoxylin-eosin stain, immunohistochemistry (CD34 and smooth muscle actin), and Masson's trichrome stain.Main Outcome Measures: Comparative analysis of different components of the fibrovascular proliferation (CD34, smooth muscle actin, and collagen) among the study groups.Results: Pan-endothelial marker CD34 expression levels starting from day 5 postinjection were significantly less than in the control group (P < 0.001), with minimum expression (1+) in all specimens removed at or after day 30 postinjection. Positive staining for smooth muscle actin was barely detected in the control eyes at day 1, and consistently intense at day 15 and beyond (P < 0.001). The expression level of trichrome staining was significantly high at day 10, compared with control eyes (P < 0.001), and continued to increase at subsequent surgical time points.Conclusions: A profibrotic switch was observed in diabetic fibrovascular proliferation after IVB, and our results suggest that at approximately 10 days post-IVB the vascular component of proliferation is markedly reduced, whereas the contractile components (smooth muscle actin and collagen) are not yet abundant.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011;118:636-641 (C) 2011 by the American Academy of Ophthalmology.