Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy
Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy
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DOI：
10.1016/j.ophtha.2006.05.064
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发表时间：
2006-10-01
期刊：
影响因子：
13.7
通讯作者：
Patel, Arun
中科院分区：
文献类型：
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作者：
Avery, Robert L.;Pearlman, Joel;Patel, Arun
目的：报道玻璃体内贝伐单抗对继发于糖尿病的视网膜和虹膜新生血管患者的生物学效应。设计：干预性、连续性、回顾性、病例系列研究。参与者：32例继发于糖尿病的视网膜和/或虹膜新生血管患者的45只眼。方法：患者接受玻璃体内贝伐单抗（6.2 μ g-1.25 mg）。眼科评价包括非标准化Snellen视力（VA），完整的眼科检查，荧光素血管造影，光学相干断层扫描。主要结果措施：荧光素血管造影渗漏的增殖性糖尿病视网膜病变（PDR）的变化。次要结局包括Snellen VA的变化。结果：未观察到显著的眼部或全身不良事件。所有经荧光素血管造影证实的新生血管患者（44/44只眼）在注射后1周内新生血管渗漏完全（或至少部分）减少。26只眼中有19只（73%）的椎间盘新生血管造影渗漏完全消退，11只眼中有9只（82%）的虹膜新生血管渗漏完全消退。早在注射后24小时就观察到渗漏减少。除了血管造影渗漏减少外，许多患者的新血管形成在临床上似乎是渐开线的，其直径减小或存在灌注血管。在2例病例中，观察到对侧未注射眼的视网膜或虹膜新生血管渗漏轻微减少，提高了玻璃体内注射后达到治疗性全身水平的可能性。荧光素渗漏的复发率各不相同。复发性渗漏被视为早在2周的情况下，而在其他情况下，没有复发性渗漏，注意到在最后一次随访的11 weeks.Conclusions：短期结果表明，玻璃体内贝伐单抗是耐受性良好，并与视网膜和虹膜新生血管继发于PDR的快速回归。观察到一致的生物学效应，即使是最低剂量（6.2 μ g），也支持概念验证。在对侧眼中观察到可能的治疗作用引起了对接受玻璃体内贝伐珠单抗（1.25 mg）治疗的患者可能出现全身性副作用的担忧，较低剂量可能获得治疗结果，全身性副作用风险较低。需要进一步研究。
Purpose: To report the biologic effect of intravitreal bevacizumab in patients with retinal and iris neovascularization secondary to diabetes mellitus.Design: Interventional, consecutive, retrospective, case series.Participants: Forty-five eyes of 32 patients with retinal and/or iris neovascularization secondary to diabetes mellitus.Methods: Patients received intravitreal bevacizumab (6.2 mu g-1.25 mg). Ophthalmic evaluations included nonstandardized Snellen visual acuity (VA), complete ophthalmic examination, fluorescein angiography, and optical coherence tomography.Main Outcome Measures: Change in fluorescein angiographic leakage of the proliferative diabetic retinopathy (PDR). Secondary outcomes included changes in Snellen VA.Results: No significant ocular or systemic adverse events were observed. All patients with neovascularization demonstrated by fluorescein angiography (44/44 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 1 week after the injection. Complete resolution of angiographic leakage of neovascularization of the disc was noted in 19 of 26 (73%) eyes, and leakage of iris neovascularization completely resolved in 9 of 11 (82%) eyes. The leakage was noted to diminish as early as 24 hours after injection. In addition to the reduction in angiographic leakage, the neovascularization clinically appeared to involute in many patients with a reduction in the caliber or presence of perfused blood vessels. In 2 cases, a subtle decrease in leakage of retinal or iris neovascularization in the fellow uninjected eye was noted, raising the possibility that therapeutic systemic levels were achieved after intravitreal injection. Recurrence of fluorescein leakage varied. Recurrent leakage was seen as early as 2 weeks in one case, whereas in other cases, no recurrent leakage was noted at last follow-up of 11 weeks.Conclusions: Short-term results suggest that intravitreal bevacizumab is well tolerated and associated with a rapid regression of retinal and iris neovascularization secondary to PDR. A consistent biologic effect was noted, even with the lowest dose (6.2 mu g) tested, supporting proof of concept. The observation of a possible therapeutic effect in the fellow eye raises concern that systemic side effects are possible in patients undergoing treatment with intravitreal bevacizumab (1.25 mg), and lower doses may achieve a therapeutic result with less risk of systemic side effects. Further study is indicated.