Behandlung der Patienten mit einem Venenastverschluss in Abhängigkeit von der Verschlussdauer

Purpose

The aim of this study was to evaluate the effects of intravitreal treatment with bevacizumab (IVB) compared with triamcinolone (IVT) in patients with macular edema due to branch retinal vein occlusion (BRVO) depending on the duration of BRVO.

Methods

A total of 65 BRVO patients were divided into 2 subgroups: group 1 with early treatment (≤?3 months since onset of BRVO) and group 2 with late treatment (>?3 months since onset). For the two groups IVB was injected into 17 eyes as early (IVB1) and into 18 eyes as late (IVB2) treatment. For comparison IVT was injected into 14 eyes as early (IVT1) and into 16 eyes as late (IVT2) treatment. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were analyzed at baseline, 1, 3 and 6 months after treatment.

Results

In both subgroups a significant improvement of BCVA and CRwas observed. After 6 months, for patients with early treatment, IVB1 showed better results than IVT1 (BCVA: p?=?0.008, CRT: p?=?0.021). In the late treatment no significant differences between IVT2 and IVB2 were found.

Conclusions

Bevacizumab and triamcinolone significantly improved BCVA and CRT in patients with BRVO. The best BCVA was found if bevacizumab was used as early treatment. In the late treatment no significant differences between bevacizumab and triamcinolone were observed.     

曲安奈德和激光治疗静脉阻塞性黄斑水肿

目的：观察并对比玻璃体腔注射曲安奈德（TA）和激光光凝治疗视网膜静脉阻塞性黄斑水肿的效果,探讨两者联合治疗的必要性及联合治疗的时机。方法：对非缺血型分支静脉阻塞累及中心凹且有灌注的黄斑水肿（中央视网膜厚度≥300μm）患者,随机分为TA组和激光组,采用双盲法进行前瞻性治疗。TA组（46眼）玻璃体腔注射曲安奈德4mg,激光组（44眼）行血管弓内格栅样光凝及无灌注区播散光凝。采用最佳矫正视力（BCVA）和相干光断层扫描（OCT）作为评价两种方法治疗前后不同时期疗效的主要指标,应用独立样本t检验对数据进行统计学处理。结果：中央视网膜厚度介于300～500μm,1wk～1mo时TA组改善视力和减轻黄斑水肿的程度较激光组非常显著;1～3mo时TA组治疗效果随时间延长呈缓慢下降趋势,而激光组呈缓慢稳定上升趋势;6mo时TA组和激光组治疗效果无显著差异;6moTA组个别患者黄斑水肿复发需再次注射。结论：对于视网膜分支静脉阻塞性黄斑水肿中央视网膜厚度介于300～500μm,玻璃体腔注射TA及激光光凝均可以选择;对中央视网膜厚度≥500μm患者可采用联合治疗,TA联合光凝治疗的时机应在玻璃体腔注射TA后1wk～1mo内积极进行;玻璃体腔注射TA后黄斑水肿复发,再次注射需间隔6mo以上。     

Intravitreal ranibizumab for macular oedema secondary to retinal vein occlusion: a retrospective study of 34 eyes

Purpose: To evaluate the efficacy and the safety of intravitreal ranibizumab injection (Lucentis) in eyes with macular oedema secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). Methods: The files of consecutive patients (34 eyes, 15 CRVO, 19 BRVO) were retrospectively analysed. Intravitreal injections of 0.5 mg ranibizumab were administered; retreatment was based on acuity visual changes and optical coherence tomography findings. Patients received 2–4 injections (mean, 2.1). Mean follow‐up was 7 months. Results: After the first injection, mean best‐corrected visual acuity (BCVA) improved from 20/160 to 20/80 and mean central retinal thickness (CRT) decreased significantly from 549 to 301 μm (p < 0.01). For each injection, BCVA improvement was on average nine letters (p < 0.01) and macular oedema reduction was 195 μm CRT (p < 0.01). The decrease in CRT was similar in CRVO and BRVO, but the improvement in BCVA was larger in BRVO. No local or systemic adverse effect was detected. Final visual acuity was correlated to initial visual acuity and to visual acuity measured after the first injection. The change in CRT was correlated to the number of injections and to initial CRT. Conclusion: Intravitreal injections of ranibizumab appeared to be a safe and effective option in the treatment of macular oedema secondary to retinal vein occlusion. Nevertheless, because the natural course has demonstrated a possible improvement in vision in almost one quarter of affected eyes at 3 years, further controlled and prospective studies are necessary to compare this treatment to the natural course with a longer follow‐up.     

Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose

To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO).

Methods

We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase.

Results

Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups.

Conclusions

Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.     

Effect of vitreomacular adhesion on antivascular endothelial growth factor therapy for macular edema secondary to branch retinal vein occlusion

Purpose

To investigate the association between vitreomacular adhesion (VMA) and the visual and anatomic outcomes of antivascular endothelial growth factor therapy for macular edema due to branch retinal vein occlusion (BRVO).

Methods

This study included 107 eyes of 107 patients with BRVO who underwent intravitreal injection of 1.25 mg bevacizumab. The presence of VMA was determined with spectral-domain optical coherence tomography (SD-OCT). All eyes underwent best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements using SD-OCT immediately before the injection and at 3, 6, 9, and 12 months after the injection. The main outcome measures were changes in BCVA and CRT from baseline.

Results

The VMA(+) and VMA(?) groups consisted of 47 and 60 eyes, respectively, and patients’ age differed significantly between the groups (P < 0.001). In both groups, BCVA and CRT improved after the injection. The VMA(+) group showed better improvement in BCVA than did the VMA(?) group (P = 0.0150), and the presence of VMA was associated with a greater decrease in CRT after adjusting for age (P = 0.0019).

Conclusions

Presence of VMA may be associated with superior visual and anatomic outcome for intravitreal bevacizumab in the treatment of macular edema due to BRVO.     

Systematic review of intravitreal bevacizumab injection for treatment of primary diabetic macular oedema

Purpose: To compare intravitreal bevacizumab (IVB) injection versus macular photocoagulation (MPC) or a combination of intravitreal bevacizumab and intravitreal triamcinolone acetonide (IVB/IVTA) injection in improving visual acuity (VA) of patients with primary diabetic macular oedema (DMO). Methods: The following databases were searched: Medline (1950 – December week 3, 2009), The Cochrane Library (Issue 4, 2009), EMBASE (up to 24 December 2009), and the TRIP database (up to 23 December 2009), using no language or other limits. Randomized controlled trials were included that consisted of patients with primary DMO (not with refractory DMO), those comparing IVB injection with MPC or IVB/IVTA injection, those reporting VA outcomes, and those having a minimum follow‐up of 6 weeks. Results: In the four randomized clinical trials comparing IVB injection with MPC, IVB injection demonstrated significantly greater improvement in VA at 6 weeks, but not at 12 weeks. In the three randomized clinical trials comparing IVB injection with IVB/IVTA, IVB injection demonstrated greater improvement in VA at 6 weeks but the benefit was again no longer significant at 12 weeks. No adjunctive effect of IVTA was demonstrated. Conclusions: Intravitreal bevacizumab injection is effective in improving VA in patients with primary DMO for 6 weeks, but the benefits are no longer present 12 weeks following the injection.     

Intravitreal triamcinolone,bevacizumab and pegaptanib for occult choroidal neovascularization

Acta Ophthalmol. 2010: 88: e305–e310

Abstract.

Purpose: To evaluate best‐corrected visual acuity (BCVA) and foveal thickness (FT) changes in occult subfoveal choroidal neovascularization (CNV) from age‐related macular degeneration (AMD) after intravitreal bevacizumab (IVB, 1.25 mg/0.05 ml), pegaptanib (IVP, 0.3 mg/0.09 ml) and triamcinolone acetonide (IVTA, 4 mg/0.1 ml) injected on an as needed basis. Methods: Retrospective, interventional, comparative study. BCVA (Early Treatment Diabetic Retinopathy Study LogMAR) and FT by optical coherence tomography (OCT) were evaluated during 12 months from first treatment. Patients were retreated if signs of neovascular activity were still present on angiography or OCT. Results: Forty‐eight eyes received IVB, 43 eyes received IVP, 52 eyes received IVTA. BCVA and FT at baseline were 1.22 ± 0.49 LogMAR and 410.2 ± 41.83 μm in the IVB group, 1.25 ± 0.43 LogMAR and 452.3 ± 44.83 μm in the IVP group and 1.31 ± 0.4 LogMAR and 456.6 ± 48.27 μm in the IVTA group. BCVA and FT improved in the three groups during follow‐up. A significantly greater improvement of BCVA was present at month‐3, month‐6 and at month‐12 in the IVB and IVP groups (p = 0.01). Improvement of FT was greater in the IVTA group at month‐3 (p = 0.02), while it was greater in the anti‐Vascular Endothelial Growth Factor (VEGF) groups at month‐6 and month‐12 (p = 0.01). A postoperative increase of intraocular pressure was detected in 9/52 (17.3%) eyes treated with IVTA, and in two cases it was resistant to topical therapy. Conclusion: Intravitreal injection of anti‐VEGF drugs administered on an as needed basis for AMD‐related occult CNVs provided functional and anatomic improvement during 12 months of follow‐up.     

Comparison of two doses of intravitreal bevacizumab (Avastin) for treatment of macular edema secondary to branch retinal vein occlusion: results from the Pan-American Collaborative Retina Study Group at 6 months of follow-up

PURPOSE: To report the 6-month anatomical and visual outcomes after injecting two different doses of intravitreal bevacizumab in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: An interventional, retrospective multicenter study of 45 eyes that were treated with at least one intravitreal injection (24 eyes, 1.25 mg; 21 eyes, 2.5 mg) of bevacizumab is reported. The main outcome measures were the central 1-mm macular thickness (CMT) and the change in ETDRS lines of best-corrected visual acuity (BCVA) at 6 months. RESULTS: Forty-five eyes were injected on average 26.1 months (range, 3-86 months) after the diagnosis. The average follow-up was 35.2 weeks (range, 24-52 weeks). All patients completed at least 6 months of follow-up. In the 1.25-mg dose group, at 1 month, there was an average gain of 4.5 lines of BCVA; at 3 months, 5.1 lines of BCVA; and at 6 months, 5.1 lines of BCVA (P < 0.005). In the 2.5-mg dose group, at 1 month, there was an average gain of 2.3 lines of BCVA; at 3 months, 3.8 lines of BCVA; and at 6 months, 4.8 lines of BCVA (P = 0.05). In the 1.25-mg dose group, the mean CMT +/- SD decreased from 461 +/- 211 microm at baseline to 321 +/- 152 microm at 1 month, 273 +/- 99 microm at 3 months, and 277 +/- 114 microm at 6 months (P = 0.0002). In the 2.5-mg group, the mean CMT +/- SD decreased from 385 +/- 168 microm at baseline to 279 +/- 111 microm at 1 month, 249 +/- 97 microm at 3 months, and 240 +/- 93 microm at 6 months (P = 0.011). CONCLUSION: There were no statistically significant differences between the two dose groups with regard to the number of injections and anatomical and functional outcomes. Intravitreal injection of bevacizumab at doses up to 2.5 mg appears to be effective in improving BCVA and reducing CMT in BRVO in the short term. Multiple injections are needed in a large number of eyes for continued control of macular edema and preservation of visual acuity in the short term. Longer studies are needed to determine what role if any intravitreal injection of bevacizumab may play in the long-term treatment of this condition.     

Matrix γ-carboxyglutamate protein and Fetuin-A, in wet type age-related macular degeneration

AIM:To compare therapeutic effects of intravitreal triamcinolone acetonide (IVTA) versus intravitreal bevacizumab (IVB) injections for bilateral diffuse diabetic macular edema (DDME).METHODS: Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 mL IVTA was injected to one eye and 2.5 mg/0.1 mL IVB was injected to the other eye. The effects of injection for diabetic macular edema (DME) were evaluated using best-corrected visual acuity (BCVA), central macular thickness (CMT) by optical coherence tomography (OCT) and intraocular pressure (IOP) by applanation tonometer. Patients underwent eye examinations, including BCVA, CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24wk after injection. During the follow-up, second injections were performed to eyes which have CMT greater than 400 µm at 12wk for salvage therapy.RESULTS: BCVA (logarithm of the minimum angle of resolution) at pre-injection, 1, 4, 8, 12 and 24wk after injection was 0.71±0.19, 0.62±0.23, 0.63±0.12, 0.63±0.13, 0.63±0.14 and 0.61±0.24 in the IVTA group and 0.68±0.25, 0.61±0.22, 0.60±0.24, 0.62±0.25, 0.65±0.26 and 0.59±0.25 in the IVB group, respectively. CMT (μm) at pre-injection, 1, 4, 8, 12 and 24wk after injection was 544±125, 383±96, 335±87, 323±87, 333±92, 335±61 in the IVTA group and 514±100, 431±86, 428±107, 442±106, 478±112, 430±88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at 12wk, and 38% at 24wk in the IVTA group. Second IVTA injections were performed to the 6 eyes (30%) at 12wk. Reduction ratios of mean CMT were 16% at 1wk, 17% at 4wk, 14% at 8wk, 7% at 12wk, and 16% at 24wk in the IVB group. Second IVB injections were performed to the 15 eyes (75%) at 12wk.CONCLUSION:This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab.     

Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation

PURPOSE: To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. RESULTS: The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 +/- 4.5 months. BCVA was 0.06 +/- 0.30 and 0.17 +/- 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 +/- 122.1microm and 389.0 +/- 171.9 microm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. CONCLUSION: IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.     

Efficacy and safety of one intravitreal injection of bevacizumab in diabetic macular oedema

Purpose: To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). Methods: Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit‐lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2–4, 8 and 12 weeks post‐injection. Best corrected VA and CRT were analysed in both groups. Results: In the non‐pretreated group, mean BCVA improved from 0.76 ± 0.33 (baseline) to 0.57 ± 0.30 and 0.54 ± 0.27 at 2–4 weeks and 8 weeks post‐injection, respectively (p = 0.02, p = 0.014, paired t‐test). Mean CRT decreased from 632.4 ± 196.0 μm (baseline) to 392.3 ± 113.6 μm and 370.4 ± 141.7 μm at the same time‐points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 ± 0.30 (baseline) to 0.53 ± 0.33 at 2–4 weeks post‐injection (p = 0.01), and mean CRT decreased from 583.9 ± 180.7 μm (baseline) to 404.1 ± 197.9 μm at 2–4 weeks post‐injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post‐injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side‐effects developed during follow‐up. Conclusions: One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.     

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best‐corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired‐t test. Side‐effects were monitored. Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow‐up, BCVA and CFT were significantly different compared to pre‐injection values in the same group (P = 0.032, 0.049 in the initial‐injection group and P = 0.001, 0.008 in the repeat‐injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time‐point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post‐injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.     

Chemokines in aqueous humour before and after intravitreal triamcinolone acetonide in eyes with macular oedema associated with branch retinal vein occlusion

Purpose: To determine the aqueous humour levels of chemokines before and after an intravitreal injection of triamcinolone acetonide (IVTA) in eyes with macular oedema associated with a branch retinal vein occlusion (ME‐BRVO). Design: Single‐centre, prospective, consecutive interventional case series. Participants: Seventeen eyes of 17 consecutive patients with ME‐BRVO who underwent IVTA were studied. Seven eyes without retinal vascular disease served as control. Intervention: All patients with ME‐BRVO underwent IVTA. Main outcome measures: The optical coherence tomographically determined foveal thickness (FT) and the aqueous humour levels of inflammatory chemokines of the C‐C subfamily, including eotaxin, monocyte chemotactic protein‐1 (MCP‐1), macrophage inflammatory protein‐1α (MIP‐1α), β (MIP‐1β), and RANTES was determined before the IVTA (baseline) and at 1 week after the IVTA. Results: At the baseline, only MCP‐1 and MIP‐1β were detected in the aqueous, and MIP‐1β was significantly higher in eyes with a ME‐BRVO than in controls (p = 0.004). The level of both of these chemokines was not correlated with the FT (p = 0.654 and p = 0.608, respectively). One week after IVTA, the FT was significantly decreased (p < 0.001), and the levels of MCP‐1 and MIP‐1β were also significantly reduced (p < 0.001 and p = 0.044, respectively). The decrease in the FT was correlated with the decrease in only MIP‐1β (r = 0.58, p = 0.020). Conclusions: Alterations of the aqueous level of MIP‐1β reflect the improvement of the macular oedema after IVTA in eyes with ME‐BRVO. This indicates that the steroid‐dependent ME‐BRVO was closely related with the level of MIP‐1β.     

玻璃体腔注射曲氨奈德与Bevacizumab治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿疗效比较

目的 比较玻璃体腔注射曲氨奈德(triamcinoloneacetonide,TA)与抗血管内皮生长因子单克隆抗体(Bevacizumab)治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿(NI-CME)的临床疗效.方法 采用单中心非随机对照临床回顾性研究,共47例经眼科常规检查以及荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查确诊的NI-CME患者的47只眼纳入观察.患者被分成两组进行玻璃体腔注射TA(4mg/0.1m1)或Bevacizumab(1.25rag/0.05m1)治疗.TA组28例,注射次数1～2次,随诊时间(5.98 4±4.35)月.Bevacizumab组19例,注射次数1-3次,随诊时间(3.20±2.92)月.两组在术前年龄、病程、最佳矫正视力(BCVA)、中心视网膜厚度(CMT)方面均无统计学意义.比较治疗前和治疗后4、8、12周两组间以及各组内部的BCVA、CMT的改变.结果 两组间视力在4周(t=0.141,P=0.889)、8周(1=-1.637,p=0.127)、12周(t=-0.479,P=0.650)时均无统计学意义;CMT在4周(t=0.479,P=0.650)、8周(t=0.743,P=0.478)、12周(t=-1.979,P=0.083)时均无统计学意义.治疗后眼压明显升高仅见于TA组.结论 玻璃体腔注射TA或Bevacizumab治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿,短期内均能明显改善视力,减轻黄斑水肿.此结果还需大样本、多中心的临床随机对照研究.     

Triamcinolone‐induced cataract in eyes with diabetic macular oedema: 3‐year prospective data from a randomized clinical trial

Purpose: To describe the 3‐year risk of cataract after intravitreal triamcinolone (IVTA) injections for diabetic macular oedema and the outcomes of cataract surgery. Methods: Prospective data from a randomized clinical trial were analysed. At baseline, 27 phakic eyes with diabetic macular oedema were randomized to receive IVTA and 25 to receive sham injection. After 2 years, initial sham‐treated eyes were eligible to receive IVTA as the study became open label for the third year. The cumulative incidence of cataract surgery was the primary outcome of the study. Other outcomes assessed included progression of cataract, best‐corrected logarithm of the minimal angle of resolution visual acuity before and after surgery and central macular thickness. Results: Over the 3 years of the study, 15/27 (56%) phakic eyes in the IVTA treated group underwent cataract surgery as compared with 2/25 (8%) initial sham‐treated eyes (P < 0.001). Mean visual acuity 6 months after cataract surgery was better than at entry into the trial. Two (15%) of the eyes in the IVTA‐treated group undergoing cataract surgery had a loss of >15 letters. In the IVTA‐treated group, 10/15 (67%) eyes that had three or more injections had progression of posterior subcapsular cataract by ≥2 grades as compared with only 2/12 (17%) eyes that had fewer than three injections (P = 0.009). Conclusions: Over half of the eyes receiving IVTA injections for diabetic macular oedema required cataract surgery within 3 years. In eyes with three or more IVTA injections, two‐thirds had progression of posterior subcapsular cataract. Visual outcomes after cataract surgery were generally good, although a small proportion of eyes lost greater than 15 letters over the course of the study.     

Intravitreal triamcinolone acetonide versus bevacizumab therapy for macular edema associated with branch retinal vein occlusion

Purpose  

To compare visual outcomes after intravitreal triamcinolone acetonide (IVTA) injection and intravitreal bevacizumab (IVB) administration for treatment of macular edema associated with branch retinal vein occlusion (BRVO).     

玻璃体腔注射曲氨奈德与bevacizumab 治疗糖尿病性黄斑水肿疗效比较

目的 对比分析玻璃体腔注射曲氨奈德(TA)与抗血管内皮生长因子单克隆抗体(bevacizumab)治疗糖尿病黄斑水肿(DME)的临床疗效.方法 经眼科常规检查和光学相干断层扫描(OCT)检查确诊,共68例82只眼DME患者纳入观察.患者被分成两组进行玻璃体腔注射TA(4mg/0.1ml)或bevacizumab(1.25mg/0.05ml)治疗.TA组37例45只眼,bevaicizumab组31例37只眼,两组在年龄、糖尿病病程、黄斑水肿病程、最佳矫正视力(BCVA)、中心视网膜厚度(CMT)、眼压等方面均无显著差异.比较治疗后4、8、12周两组间BCVA、CMT、眼压的改变.结果 TA组与bevacizumab组在治疗后4 周、8周、12周时视力差异无统计学意义(t=-0.316,0.896、0.879,P=0.754、0.389、0.384).治疗后4周、12周时,TA组比bevacizumab组黄斑水肿有显著下降(t=-1.892、-3.007,P=0.036、0.004),8周时差异无统计学意义(t=-0.362,P=0.722).眼压在治疗后8周、12周时两组差异有统计学意义(t=2.334、2.600,P=0.026、0.015),TA组眼压明显高于bevacizumab组.结论 玻璃体腔注射TA比bevacizumab更早、更有效地降低糖尿病黄斑水肿,并且维持时间更长,此结果还需大样本、多中心的临床随机对照研究.     

Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration

PURPOSE: To investigate the efficacy and safety of intravitreal bevacizumab for managing choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Prospective interventional case series. METHODS: Seventeen eyes of 17 patients with subfoveal CNV due to AMD participated in this study at the American University of Beirut Ophthalmology Clinics. All patients had failed, refused, or were not eligible for photodynamic therapy. All eyes received a baseline eye examination, which included best-corrected visual acuity (BCVA), dilated fundus examination, ocular coherence tomography (OCT) imaging, and fluorescein angiography. An intravitreal injection of bevacizumab (2.5 mg/0.1 ml) was given at baseline and followed by two additional injections at four-week intervals. BCVA, OCT, and fluorescein angiography were repeated four weeks after each injection. Main outcome measures were improvement in BCVA and central retinal thickness (CRT). RESULTS: Mean baseline BCVA was 20/252 (median 20/200), and baseline CRT was 362 microm (median 350 microm). Improvement in VA and CRT occurred by the fourth week. At 12 weeks, mean BCVA was 20/76 (P < .001) and median BCVA was 20/50 (P < .001). Both mean and median CRT decreased to 211 microm (P < .001). Thirteen (76%) of 17 eyes had total resolution of subretinal fluid, and four eyes (24%) had BCVA better than 20/50. No systemic or ocular side effects were noted at any time. CONCLUSION: Eyes with CNV due to AMD treated with intravitreal bevacizumab had marked anatomic and visual improvement. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.     

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.     

玻璃体腔内注射Bevacizumab治疗年龄相关性黄斑变性

目的:评估抗血管内皮生长因子单克隆抗体bevacizumab(Avastin)玻璃体腔注射治疗湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效和安全性。方法:对30例接受玻璃体腔注射bevacizumab(2.5mg)治疗的AMD患者进行回顾分析,主要评价指标包括最佳矫正视力(best-corrected visual acuity,BCVA)、黄斑中心凹厚度(central foveal thickness,CFT)和黄斑容积(total macularvolume,TMV),对注射后渗漏无明显改善或病情反复者进行眼内重复注射。所有病例都完成至少6mo的观察随访。结果:患者30例30眼中男21例,女9例,平均年龄72岁。治疗前患者的基线平均对数BCVA为1.03±0.55,CFT为364.97±151.83μm,TMV为8.36±1.84mm3,注药后1wk虽然平均CFT和TMV没有显著改善,但BCVA有显著提高(logMAR,0.79±0.33;P=0.002),经平均9.7mo的随访,BCVA(logMAR,0.70±0.40;P=0.004),CFT(272.93±81.06;P=0.005)和TMV(7.20±0.98;P=0.004)3项指标均较基线有显著改善,终末随访时BCVA提高至少两行者为18眼(60%),稳定者为8眼(27%)。本组患者共接受了58次玻璃体腔内注射,平均注射次数为1.93次/眼,有50%再注射能在术后1wk使视力提高两行或两行以上。结论:玻璃体腔注射bevacizumab能够安全有效地改善或稳定多数湿性AMD的病情,但术后定期随访以及根据病情变化进行再次注射是必要的。