玻璃体腔单次注射抗血管内皮生长因子单克隆抗体Bevacizumab治疗糖尿病性黄斑水肿

目的 观察玻璃体腔单次注射抗血管内皮生长因子单克隆抗体Bevacizumab治疗糖尿病性黄斑水肿（DME）的临床疗效和安全性。 方法 前瞻性非随机对照临床研究，共18例眼科常规检查以及荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）检查确诊的DME患者的18只患眼纳入观察。患者年龄34～75岁，平均年龄（54±11）岁，无全身及局部手术禁忌症。治疗前平均logMAR最佳矫正视力(BCVA)为1.023±0.45，黄斑中心凹视网膜厚度486 μm。患眼玻璃体腔注射Bevacizumab 1.5 mg (0.06 ml)，治疗后随访观察12 ～20周，平均随访观察时间（16±4）周。对比观察治疗前后视力、眼压、OCT及FFA改变。 结果 18例患者治疗后1、4、12周的平均logMAR BCVA分别提高至0.864±0.48（P=0.001）、0.739 ±0.51（P=0.003）、0.792±0.50(P=0.015)，与治疗前比较，差异均有统计意义。治疗后12周，16只眼视力稳定或提高，占88.9％。其中，10只眼logMAR视力提高2行或以上，占55.6％；2只眼视力下降。OCT检查黄斑中心凹视网膜厚度，治疗后4周下降至413 μm，治疗后12周下降到383 μm，与治疗前比较，差异均有统计学意义 （P=0.002，P=0.001）。治疗后12周，黄斑水肿改善者13只眼，占72.2%。所有患者均未出现眼内或全身不良反应。 结论 玻璃体腔注射Bevacizumab治疗DME能明显改善患者视功能，减轻黄斑水肿，副作用少；但尚需进一步大样本、多中心的临床随机对照研究。 (中华眼底病杂志,2008,24:172-175)     

玻璃体腔重复注射抗血管内皮生长因子单克隆抗体bevacizumab对糖尿病大鼠视网膜的毒性观察

目的 观察玻璃体腔重复注射抗血管内皮生长因子(VEGF)单克隆抗体bevacizumab(商品名Avastin)对糖尿病大鼠视网膜的毒性作用.方法 40只健康成年雄性Sprague-Dawley大鼠随机分为正常组(A组)和糖尿病组,分别为10、30只.糖尿病组采用链脲佐菌霉素(STZ)尾静脉注射方法制作糖尿病动物模型.随机选取10只作为糖尿病视网膜病变(DR)组(B组),不作任何处理;其余20只大鼠左眼为实验组(C组),玻璃体腔注射25 mg/ml的bevacizumab 3 μ1,共注射3次,每次间隔10 d;右眼为实验对照组(D组),不给予任何处理.末次注射后20 d,采用闪光视网膜电图(F-ERG)对各组大鼠行视网膜功能检测;溴化乙锭(EB)染色视网膜铺片,荧光显微镜观察各组大鼠视网膜血管变化情况;苏木精-伊红(HE)染色,光学显微镜观察大鼠视网膜形态学变化;免疫组织化学染色法观察大鼠视网膜各层Thy-1及VEGF阳性表达情况.结果 F-ERG检测显示,A、B、C、D 4组暗适应a、b波潜伏期,暗适应b波振幅及振荡电位(Ops)总振幅比较,差异均有统计学意义(F=33.165,36.162,19.955,23.243;P值均=0.000);A、B、C、D4组暗适应a波振幅比较,差异无统计学意义(F=0.097,P=0.961).荧光显微镜观察发现,A组大鼠视网膜血管走行良好,B组大鼠视网膜血管走行纡曲、扩张,C组大鼠视网膜血管走形规则、变细,D组大鼠视网膜可见微血管瘤.光学显微镜观察发现,A组大鼠视网膜层次结构整齐分明,B组大鼠视网膜各层细胞结构排列紊乱,C组大鼠视网膜各层细胞排列整齐,D组大鼠视网膜各层细胞排列不整齐.免疫组织化学染色发现,Thy-1阳性表达主要位于神经节细胞层(GCL),极少数位于内丛状层、内核层.VEGF阳性表达主要定位于GCL,少量位于神经纤维层、内核层及视网膜色素上皮层.结论 玻璃体腔重复注射bevacizumab对糖尿病大鼠视网膜有一定毒性作用.

Abstract：

Objective To observe the retinal toxicity of repeated intravitreal injection with bevacizumab(Avastin)in diabetic rats.Methods Forty male Sprague Dawley(SD)rats were randomly divided into normal group(Group A,10 rats)and diabetes mellitus group(30 rats).The rats in diabetes mellitus group were induced with streptozotocin injection for diabetic retinopathy model.And then randomly divided into diabetic retinopathy(DR)group(Group B,10 rats),the rats were not intervened;the left eyes of the other 20 rats were intravitreal injected with bevaeizumab 3 μ1(25 mg/m1)for 3 times as experimental group(Group C);the right eyes of the 20 rats were not intervened as experimental control group(Group D),20 days after last intravitreal injection,retinal function was measured by Flicker Electroretinogram (F-ERG);retinal vascular pattern was determined by fluorescence microscopy of ethidium bromide(EB)stained retinal flat mounts;retinal morphological changes were determined by light microscope on hematoxylin-eosin (HE) stained sections;Thy-1 and VEGF expression was measured by immunohistochemistry staining.Results F-ERG showed that-the differences of a-and b-waves-the b-wave amplitude and the Ops-wave amplitude in the implicit time between group A,B,C and D were significant (F=33.165,36.162,19.955,23.243;P=0.000);the differences of a-wave amplitude between group A,B,C and D was not significant(F=0.097,P=0v961).Retinal blood vessel pattern was normalin Group A;retinal vascular vessels were tortuous and irregularly expanded in Group B:retinal vascular vessels of Group C were regular and thinner than Group A;microaneurysm were showed in Group D.Light microscope displayed that the layers of the rat retina of Group A were regular,the retinal architectures of Group B were irregular,the retinal layers were regular in Group C,the retinal layers were irregular in Group D.Immunohistochemistry staining discovered that Thy-1 and VEGF were mainly expressed in ganglion cell layer(GCL).Conclusion Repeated intravitreal injection of bevacizumab iS toxic tO retina of diabetes mellitus rats.     

玻璃体腔重复注射抗血管内皮生长因子单克隆抗体bevacizumab对糖尿病大鼠视网膜的毒性观察

Objective To observe the retinal toxicity of repeated intravitreal injection with bevacizumab(Avastin)in diabetic rats.Methods Forty male Sprague Dawley(SD)rats were randomly divided into normal group(Group A,10 rats)and diabetes mellitus group(30 rats).The rats in diabetes mellitus group were induced with streptozotocin injection for diabetic retinopathy model.And then randomly divided into diabetic retinopathy(DR)group(Group B,10 rats),the rats were not intervened;the left eyes of the other 20 rats were intravitreal injected with bevaeizumab 3 μ1(25 mg/m1)for 3 times as experimental group(Group C);the right eyes of the 20 rats were not intervened as experimental control group(Group D),20 days after last intravitreal injection,retinal function was measured by Flicker Electroretinogram (F-ERG);retinal vascular pattern was determined by fluorescence microscopy of ethidium bromide(EB)stained retinal flat mounts;retinal morphological changes were determined by light microscope on hematoxylin-eosin (HE) stained sections;Thy-1 and VEGF expression was measured by immunohistochemistry staining.Results F-ERG showed that-the differences of a-and b-waves-the b-wave amplitude and the Ops-wave amplitude in the implicit time between group A,B,C and D were significant (F=33.165,36.162,19.955,23.243;P=0.000);the differences of a-wave amplitude between group A,B,C and D was not significant(F=0.097,P=0v961).Retinal blood vessel pattern was normalin Group A;retinal vascular vessels were tortuous and irregularly expanded in Group B:retinal vascular vessels of Group C were regular and thinner than Group A;microaneurysm were showed in Group D.Light microscope displayed that the layers of the rat retina of Group A were regular,the retinal architectures of Group B were irregular,the retinal layers were regular in Group C,the retinal layers were irregular in Group D.Immunohistochemistry staining discovered that Thy-1 and VEGF were mainly expressed in ganglion cell layer(GCL).Conclusion Repeated intravitreal injection of bevacizumab iS toxic tO retina of diabetes mellitus rats.     

玻璃体腔重复注射抗血管内皮生长因子单克隆抗体bevacizumab对糖尿病大鼠视网膜的毒性观察

Objective To observe the retinal toxicity of repeated intravitreal injection with bevacizumab(Avastin)in diabetic rats.Methods Forty male Sprague Dawley(SD)rats were randomly divided into normal group(Group A,10 rats)and diabetes mellitus group(30 rats).The rats in diabetes mellitus group were induced with streptozotocin injection for diabetic retinopathy model.And then randomly divided into diabetic retinopathy(DR)group(Group B,10 rats),the rats were not intervened;the left eyes of the other 20 rats were intravitreal injected with bevaeizumab 3 μ1(25 mg/m1)for 3 times as experimental group(Group C);the right eyes of the 20 rats were not intervened as experimental control group(Group D),20 days after last intravitreal injection,retinal function was measured by Flicker Electroretinogram (F-ERG);retinal vascular pattern was determined by fluorescence microscopy of ethidium bromide(EB)stained retinal flat mounts;retinal morphological changes were determined by light microscope on hematoxylin-eosin (HE) stained sections;Thy-1 and VEGF expression was measured by immunohistochemistry staining.Results F-ERG showed that-the differences of a-and b-waves-the b-wave amplitude and the Ops-wave amplitude in the implicit time between group A,B,C and D were significant (F=33.165,36.162,19.955,23.243;P=0.000);the differences of a-wave amplitude between group A,B,C and D was not significant(F=0.097,P=0v961).Retinal blood vessel pattern was normalin Group A;retinal vascular vessels were tortuous and irregularly expanded in Group B:retinal vascular vessels of Group C were regular and thinner than Group A;microaneurysm were showed in Group D.Light microscope displayed that the layers of the rat retina of Group A were regular,the retinal architectures of Group B were irregular,the retinal layers were regular in Group C,the retinal layers were irregular in Group D.Immunohistochemistry staining discovered that Thy-1 and VEGF were mainly expressed in ganglion cell layer(GCL).Conclusion Repeated intravitreal injection of bevacizumab iS toxic tO retina of diabetes mellitus rats.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体Bevacizumab的不良反应三例

抗血管内皮生长因子(VEGF)单克隆抗体Bevacizumab应用于眼科治疗脉络膜新生血管(CNV)、视网膜及虹膜新生血管均显示出良好疗效[1],但是其不良反应报告不多[2].我们从2007年7月开始使用Bevacizumab进行玻璃体腔注射,临床工作中遇到一些可能与药物有关的不良反应或是难以解释的现象,现报道如下.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab治疗视网膜分支静脉阻塞伴黄斑水肿的疗效观察

血管内皮生长因子(VEGF)是潜在的新生血管刺激物,可促进血管内皮细胞增生,增加血管通透性,在视网膜分支静脉阻塞(BRVO)伴黄斑水肿的发生发展中起着重要作用[1].抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)能结合并阻断所有VEGF异构体,使内源化VEGF的生物活性失效[2].对于BRVO伴黄斑水肿的患者,单次玻璃体腔注射bevacizumab可提高患眼视力,降低黄斑中心视网膜厚度(CMT),但效果并不持久[3,4],联合激光光凝治疗较单一注射治疗对视力预后更好[5].     

抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗增生型糖尿病视网膜病变的研究现状

抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)玻璃体腔注射(IVB)能减少增生型糖尿病视网膜病变(PDR)患者视网膜血管渗出性并发症、阻止视网膜新生血管的发展、减少玻璃体积血、减少黄斑水肿导致的视力减退.全视网膜激光光凝术以及玻璃体切割手术联合IVB提高了PDR的治疗效果,降低了治疗风险和并发症.但bevacizumab以及IVB本身也存在一些不良反应或副作用需要规避;针对不同病变情况的最佳有效剂量和治疗时机也值得进一步探索.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体Ranibizumab治疗视网膜静脉阻塞继发黄斑水肿

视网膜静脉阻塞(RVO)继发的黄斑水肿是导致视力下降的常见原因,黄斑格栅样激光光凝是治疗黄斑水肿的常用方法,但是治疗后视力提高不明显[1].近年来应用玻璃体腔曲安奈德注射(IVTA)治疗RVO继发黄斑水肿具有一定效果[2,3],但仍有部分患者视力不提高.抗血管内皮生长因子(VEGF)单克隆抗体Ranibizumab是重组的人源化VEGF单克隆抗体片段,目前已获美国食品及药物管理局(FDA)批准,用于老年性黄斑变性脉络膜新生血管的治疗[4,5],最近又用于RVO继发黄斑水肿的治疗,并取得了肯定疗效[6].我们对15例RVO继发黄斑水肿患者进行了Ranibizumab玻璃体腔注射,现将结果报道如下.     

玻璃体腔重复注射抗血管内皮生长因子单克隆抗体bevacizumab对眼压的影响

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)不仅是治疗视网膜、脉络膜新生血管(CNV)相关疾病的有效方法之一~([1,2]),而且对视网膜静脉阻塞(RVO)及糖尿病视网膜病变(DR)伴发的黄斑水肿(ME)也有明显的治疗作用~([1,2]).     

抗血管内皮生长因子单克隆抗体Bevacizumab玻璃体腔注射后眼内炎一例

患者女,67岁.因右眼视力下降、视物变形就诊.否认糖尿病病史.经眼科常规检查和眼底检查后诊断为右眼老年性黄斑变性(AMD).视力0.12,眼压15.4 mm Hg(1 mm Hg=0.133kPa),外眼及眼前节正常,眼底为典型的渗出型AMD表现.在患者及家属充分了解疾病的转归和干预治疗利弊,知情同意并且在手术告知书上签字后行右眼玻璃体腔抗血管内皮生长因子(VEGF)单克隆抗体Bevacizumab注射治疗.治疗时表面麻醉下常规消毒铺巾.注入Bevacizumab 2.5 mg/0.1 ml并行前房穿刺.治疗过程顺利,治疗后典必殊眼膏涂眼,包扎治疗眼.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab后视功能的变化

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名：Avastin)后,患眼功能改善或稳定,疗效和安全性良好。其中,视功能变化表现为视力显著提高,对比敏感度稳定不变或明显改善,视网膜电图（ERG）未出现显著改变,多焦视网膜电图（mfERG）反应稳定或改善,眼电图(EOG)和视觉诱发电位(VEP)与治疗前相比无明显改变,视野保持稳定或轻微改善,色觉保持不变。但重复注射、bevacizumab联合其它治疗后的视功能变化以及长期疗效及安全性仍需更加充分的评估依据进行大样本长时间随访研究。     

抗血管内皮生长因子bevacizumab兔眼玻璃体腔重复注射的安全性研究

目的　观察抗血管内皮生长因子bevacizumab（商品名Avastin）兔眼玻璃体腔重复注射的眼内安全性。方法 14只青紫兰兔分为3组,其中12只兔的右眼设为实验组,左眼设为实验对照组,2只兔为正常对照组。实验组右眼予以25 mg/ml的bevacizumab玻璃体腔注射,实验组根据不同注射剂量分为2.5、5.0 mg 2个剂量组,左眼分别注射等剂量0.9%生理盐水作为实验对照。玻璃体腔共注射3次,每次间隔2周。每次注射前、注射后2 d,第3次注射后1、4周采用裂隙灯显微镜、+90 D前置镜、B型超声、超生生物显微镜（UBM）、光相干断层扫描（OCT）进行临床指标观察,视网膜电图（ERG）和闪光视觉诱发电位（F-VEP）进行视网膜功能检测。第3次注射完毕后1、4周分别摘取眼球进行病理组织学观察和凋亡细胞检测。结果　所有实验眼和实验对照眼均未见明显炎症反应,各组眼底未见明显异常,玻璃体无混浊、出血。B型超声、UBM和OCT检查均未见明显改变。注射前后不同剂量实验组与实验对照组、正常对照组眼压、前房闪辉计数比较,差异均无统计学意义(P＞0.05)。不同剂量实验组与注射前、实验对照组、正常对照组最大反应ERG a、b波比较,差异均无统计学意义(P＞0.05)。注射前后,F-VEP N₁波潜伏期和P1波振幅各组差异均无统计学意义(P＞0.05)。光学显微镜观察发现,不同剂量实验组第3次注射后1 周玻璃体腔可见少量炎症细胞,注射后第4周未见炎症细胞;实验对照组和正常对照组注射前后视网膜组织形态未见明显改变。5.0  mg实验组第3次注射后1周电子显微镜下可见炎症细胞,个别视细胞细胞核呈空泡样改变,其余未见明显异常。凋亡细胞计数显示,第3次注射后1周,5.0 mg实验组与2.5、5.0 mg实验对照组（Z=0.227）和正常对照组（Z=1.341）组间凋亡细胞数量比较,差异均有统计学意义（P＜0.01）,第3次注射后4周,各组差异无统计学意义（χ2=4.826,P>0.05）。结论　5.0 mg bevacizumab在兔眼玻璃体腔多次注射视网膜有一定轻微毒性反应。     

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab对增生型糖尿病视网膜病变纤维血管膜中整合素链接激酶表达的影响

目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)对增生型糖尿病视网膜病变(PDR)纤维血管膜中整合素链接激酶(ILK)表达及视网膜血管内皮细胞数量的影响.方法 玻璃体切割手术中取出的24例PDR患者的视网膜前纤维血管膜,其中12例患者手术前1周玻璃体腔单次注射bevaei...     

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab对增生型糖尿病视网膜病变纤维血管膜中整合素链接激酶表达的影响

Objective To observe the effect of intravitreal injection of bevacizumab(Avastin,IVB)on the expression of integrin-linked kinase(ILK)in fibrovascular membranes and the number of vascular endothelial cells(VECs)in proliferative diabetic retinopathy(PDR).Methods Twenty-four fibrovascular membrane samples were collected during pars plana vitrectomy in 24 patients with PDR.1 2 PDR patients had received a single 1.25 mg IVB 7 days preoperatively(bevaeizumab group),the other 1 2 patients(nonbevacizumab group)had not received lVB.For each of 24 fibrovascular membranes specimen.the number of VECs in the membranes were counted after staining with hematoxylin-eosin and yon willebrand factor.Expressions of ILK in the fibrovascular membranes were detected through immunohistochemistry analysis.Results Immunohistochemistry revealed that ILK was highly expressed in all of 24 fibrovaseular membranes of PDR.The average optieal density of ILK expression level in bevacizumab and non-bevaeizumab group were(127.78±15.08)and(129.03±16.26)respectively.the difference was not statistically significant (t=0.330,P=0.745).The number of VECs in ftbrovascular membranes in bevacizumab and nonbevaeizumab group were 21.50±3.94 and 41.33±7.44 respectively,the difference was statistically significant(t=3.872,P=0.003).Condusiom ILK was expressed in fibrovascular membranes of PDR.IVB can decrease the number of VECS during the process of PDR,but it can not affect the expression of ILK protein.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab对增生型糖尿病视网膜病变纤维血管膜中整合素链接激酶表达的影响

Objective To observe the effect of intravitreal injection of bevacizumab(Avastin,IVB)on the expression of integrin-linked kinase(ILK)in fibrovascular membranes and the number of vascular endothelial cells(VECs)in proliferative diabetic retinopathy(PDR).Methods Twenty-four fibrovascular membrane samples were collected during pars plana vitrectomy in 24 patients with PDR.1 2 PDR patients had received a single 1.25 mg IVB 7 days preoperatively(bevaeizumab group),the other 1 2 patients(nonbevacizumab group)had not received lVB.For each of 24 fibrovascular membranes specimen.the number of VECs in the membranes were counted after staining with hematoxylin-eosin and yon willebrand factor.Expressions of ILK in the fibrovascular membranes were detected through immunohistochemistry analysis.Results Immunohistochemistry revealed that ILK was highly expressed in all of 24 fibrovaseular membranes of PDR.The average optieal density of ILK expression level in bevacizumab and non-bevaeizumab group were(127.78±15.08)and(129.03±16.26)respectively.the difference was not statistically significant (t=0.330,P=0.745).The number of VECs in ftbrovascular membranes in bevacizumab and nonbevaeizumab group were 21.50±3.94 and 41.33±7.44 respectively,the difference was statistically significant(t=3.872,P=0.003).Condusiom ILK was expressed in fibrovascular membranes of PDR.IVB can decrease the number of VECS during the process of PDR,but it can not affect the expression of ILK protein.     

手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab预防增生型糖尿病视网膜病变玻璃体切割手术后玻璃体积血的meta分析

目的 系统评价手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(IVB)预防增生型糖尿病视网膜病变(PDR)玻璃体切割手术后玻璃体积血(VH)的有效性和安全性.方法 随机对照试验(RCT)的Meta分析.计算机检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库和中国期刊全文数据库,并辅以手工检索相关书籍、期刊和会议论文及其参考文献.按照纳入和排除标准筛选评价手术前IVB预防PDR玻璃体切割手术后VH的RCT.对纳入的RCT进行数据提取后,采用Jadad评分量表进行质量评价.分析指标包括手术后VH发生率、最佳矫正视力(BCVA)、视网膜复位率和并发症发生率.统计学分析使用Stata/SE 11.2软件,连续变量采用加权平均差(WMD)及其95％可信区间(CI)表示,非连续变量采用比值比(OR)及其95％ CI表示,结果 共纳入7项符合标准的RCT,其中IVB组170例,对照组161例.纳入的RCT Jadad评分仅1项为5分,1项为3分,其余5项均为1分.手术后≤4周和手术后＞4周,IVB组VH发生率低于对照组,差异均具有统计学意义(OR=3.28,95％ CI:1.58～6.82,P=0.00;OR=2.51,95％ CI:1.21～5.22,P=0.01).手术后3个月和手术后6个月,IVB组VH发生率与对照组比较,差异均无统计学意义(OR=2.52,95％ CI:0.74～8.57,P=0.14;OR=3.26,95％ CI:0.50～21.45,P=0.22).IVB组手术后BCVA优于对照组,差异具有统计学意义(WMD=0.29,95％ CI:0.13～0.44,P=0.00).IVB组手术后视网膜复位率与对照组比较,差异无统计学意义(OR=0.39,95％ CI:0.10～1.59,P=0.19).IVB组手术后视网膜再脱离发生率与对照组比较,差异无统计学意义(OR=2.36,95％ CI:0.74～7.56,P=0.15);IVB组手术后新生血管性青光眼发生率与对照组比较,差异无统计学意义(OR=1.47,95％ CI:0.28～7.71,P=0.65).结论 手术前IVB能够有效预防PDR玻璃体切割手术后VH,且相对较为安全,但仍需高质最、多中心、大样本、长期随访的RCT进一步研究证实.     

兔眼玻璃体腔注射抗血管内皮生长因子单克隆抗体Bevacizumab的视网膜毒性研究

目的 观察不同剂量抗血管内皮生长因子单克隆抗体Bevacizumab兔眼玻璃体腔注射的视网膜毒性作用。 方法 16只新西兰无色素兔的32只眼随机分为药物注射组和对照组，药物注射组又根据玻璃体腔注射药物剂量不同分为A、B、C组，玻璃体腔注射Bevacizumab剂量分别为0.05、0.10、0.25 ml，分别含Bevacizumab 1.25、2.50、6.25 mg。对照组玻璃体腔注射0.9％生理盐水0.10 ml。注药后1、2、4周行视网膜电图（ERG）检查。另外 ，在兔眼玻璃体腔注射Bevacizumab后1、2、4周，每组各摘除2只兔眼，行视网膜组织形态及超 微结构的光学显微镜和透射电子显微镜观察。 结果 兔眼玻璃体腔注射 Bevacizumab后1、2、4周，兔眼ERG各项反应波形均正常，振幅均未出现异常改变（P＞0.05）。光学显微镜下观察 ，药物注射组和对照组视网膜各层组织形态在各时间点均未见异常。透射电子显微镜观察， A、B组与对照组无明显差异；C组视网膜光感受器细胞出现部分线粒体损伤，发生肿胀和积 水变，4周时病变无缓解。 结论 单次兔眼玻璃体腔注射Bevacizumab 1.25 mg或2.50 mg是安全的。 （中华眼底病杂志，2008，24：193-196）     

渗出型老年性黄斑变性玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab前后房水中血管内皮生长因子浓度变化

国内外研究表明,血管内皮生长因子(VEGF)生成增加可刺激脉络膜新生血管(CNV)形成~([1,2]).玻璃体腔注射抗VEGF单克隆抗体bevacizumab(商品名Avastin)能减轻视网膜水肿,提高视力,成为目前治疗CNV疾病最重要的方法之一~([3-5]).     

高度近视脉络膜新生血管患者玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab后房水中血管内皮生长因子含量变化

血管内皮生长因子(VEGF)在高度近视、老年性黄斑变性等疾病伴发的脉络膜新生血管(CNV)发生发展中起着重要作用~([1,2]),抗VEGF单克隆抗体bevacizumab(商品名Avastin)可与所有已知VEGF异构体结合,通过抑制其生物学活性而起到抗VEGF的作用~([3,4]).     

玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察

目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab（IVR）辅助微创玻璃体视网膜手术（VRS）治疗严重增生型糖尿病视网膜病变（PDR）的临床效果。方法 回顾性非随机临床对照研究。临床确诊为严重PDR的60例患者70只眼纳入研究。依据手术前是否行IVR治疗将患者分为IVR组和对照组。IVR组31例35只眼,对照组29例35只眼。IVR组于手术前3～4 d玻璃体腔注射10 mg/ml的ranibizumab 0.05 ml（含ranibizumab 0.5 mg）,然后行23G微创VRS。对照组直接行23G微创VRS。手术后随访3~12个月,平均随访时间（4.5±1.8）个月。对比分析两组患者最小分辨角对数（logMAR）最佳矫正视力（BCVA）、眼压、黄斑中心凹视网膜厚度（CRT）和视网膜复位及手术后并发症的发生情况。结果 IVR组患者均未发生与注射及药物相关的局部及全身不良反应。手术后1周,1、3个月,IVR组玻璃体积血（VH）发生率分别为8.6%、0.0%、0.0%,对照组VH发生率分别为28.6%、17.1%、8.6%。两组手术后各时间点VH发生率比较,手术后1周及1个月之间差异有统计学意义（χ²=4.63、4.56,P＜0.05）,手术后3个月之间差异无统计学意义（χ²=0.24,P＞0.05）。IVR组、对照组手术后平均logMAR BCVA分别为0.81±0.40、1.05±0.42,均较手术前提高。IVR组、对照组手术前后平均logMAR BCVA比较,差异有统计学意义（t=12.78、4.39,P＜0.05）。IVR组手术后平均logMAR BCVA较对照组提高,两组手术后平均logMAR BCVA比较,差异有统计学意义（t=-2.36,P＜0.05）。IVR组、对照组手术后平均CRT分别为（297.6±79.8）、（347.6±85.0） μm,两组平均CRT比较,差异有统计学意义（t=-2.53,P＜0.05）。IVR组、对照组手术后视网膜复位率分别为97.1%、94.3%,两组视网膜复位率比较,差异无统计学意义（χ²=0.35,P＞0.05）。IVR组、对照组一过性高眼压发生率分别为14.3%、34.3%,两组间一过性高眼压发生率比较,差异有统计学意义（χ²=4.79,P＜0.05）。IVR组、对照组视网膜前膜、新生血管性青光眼等并发症发生情况比较,差异也无统计学意义（χ²=0.97、0.51,P＞0.05）。结论 IVR辅助23G微创VRS治疗严重PDR能提高患者视力,降低手术后VH发生率,减小CRT。