玻璃体腔注射贝伐单抗治疗糖尿病性黄斑水肿疗效观察

目的评估玻璃体腔注射贝伐单抗bevacizumab（Avastin）治疗糖尿病性黄斑水肿（DME）的疗效。方法回顾分析接受玻璃体腔注射Avaslin治疗DME的患者57例（68眼）,所有患者均接受玻璃体腔内注射Avastin 1．25mg（0．05mE）。治疗前及治疗后1、2、3d,3、6、12周进行最佳矫正视力（BCVA）、眼压、裂隙灯及间接检眼镜检查。治疗前及治疗后3、6、12周行光学相干断层扫描（OCT）检查。治疗前及治疗后6周、12周行彩色眼底照相、荧光素眼底血管造影（FFA）检查。有21、13、2眼分别需要注射2、3、4次。随访时间2～19个月,平均（3．1±1．62）个月。对比分析治疗前后患者视力及黄斑中心视网膜厚度（CMT）的改变。结果治疗后患者视力明显提高,CMT平均值治疗前为（506．19±153．78）μm,治疗后3、6、12周时均明显减低（t=3．45,3．18,3．46,P〈0．05）,治疗后末次随诊时为（379．10±166．32）μm,与术前相比差异有统计学意义（t=4．719,P=0．000）。随访中未见眼压异常改变及白内障的进展,未见与药物有关的眼部和全身不良反应。结论玻璃体腔注射Avastin后,黄斑水肿明显减轻,视力稳定并提高,必要时需要连续注射治疗,长期效果需进一步观察。     

玻璃体内注射贝伐单抗联合视网膜激光光凝治疗糖尿病性黄斑水肿

目的：探究玻璃体内注射贝伐单抗联合视网膜激光光凝治疗糖尿病黄斑水肿的治疗效果以及分析此方法的安全性。
　　方法：选取2014-02/2015-03期间于我院确诊并治疗的69例82眼糖尿病黄斑水肿,随机平均分为对照组与观察组,每组41眼。观察组患者行玻璃体内注射贝伐单抗联合视网膜激光光凝治疗,对照组行单纯视网膜激光光凝治疗。治疗后观察并对比两组患者最佳矫正视力情况(BCVA)、黄斑中心凹厚度(CMT)、荧光素眼底血管造影改变( FFA)以及眼压变化等并发症情况。
　　结果：观察组于治疗后1、3、6 lo BCVA、CMT较治疗前有明显改善( P<0.05);对照组治疗前后BCVA未见明显提高(P>0.05),CMT较治疗前有所降低(P<0.05),但FFA结果6 lo后反弹。观察组较对照组在BCVA、CMT方面差异具有统计学意义(P<0.05),且两组治疗后1、3、6lo均未发生眼部及全身性并发症。
　　结论：玻璃体内注射贝伐单抗联合视网膜激光光凝治疗糖尿病黄斑水肿治疗效果更优,而且基本无眼部及全身性并发症。     

玻璃体腔注射Bevacizumab联合视网膜光凝治疗糖尿病性黄斑水肿

目的: 评价玻璃体腔注射1.25mg贝伐单抗(Bevacizum ab)注射液后行黄斑区激光光凝治疗糖尿病性弥漫性黄斑水肿的临床效果。方法: 随机将74例86眼糖尿病性黄斑水肿引起视力下降的患者分成两组,即治疗组和对照组。治疗组43例48眼玻璃体腔注射Bevacizum ab注射液1.25mg,3wk后进行局部或格栅样视网膜光凝。对照组31例38眼单纯玻璃体腔注射Bevacizum ab注射液1.25mg,跟踪观察治疗前、治疗后3,6wk;3mo两组视力情况与视网膜厚度的变化。结果: 两组视力比较,治疗前、治疗后3wk时无统计学意义,两组间治疗后6wk;3mo比较差异有显著性。治疗组黄斑中心凹厚度在治疗前,治疗后3,6wk;3mo分别为395.933±119.784,292.617±39.131,302.350±55.272,314.200±60.528μm。对照组治疗前,治疗后3,6wk;3mo分别为398.734±111.764,301.217±34.231,312.120±53.170,395.145±108.687μm。两组在治疗前、治疗后3wk视网膜厚度无统计学意义,但在治疗后6wk和3mo时差异有统计学意义。结论: 玻璃体腔注射Bevacizum ab后联合黄斑激光光凝治疗糖尿病性弥漫性黄斑水肿更有效,有利于视网膜光凝,并且能提高糖尿病性黄斑水肿患者的视力。     

玻璃体腔注射贝伐单抗治疗增生性糖尿病视网膜病变

糖尿病视网膜病变（diabetic retinopathy,DR）是糖尿病的严重并发症,尤其是增生性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）是工作年龄人群中首位致盲性眼病.近年来采用血管内皮生长因子抑制剂贝伐单抗（Bevacizumab,商品名Avastin）治疗PDR取得一定成效,其可促进玻璃体积血吸收,视网膜新生血管消退,减轻黄斑水肿,降低视网膜脱离的发生率,甚至使PDR患者避免玻璃体手术.     

玻璃体腔注射贝伐单抗Avastin后糖尿病视网膜患者血清中VEGF含量的变化研究

目的研究玻璃体腔注射贝伐单抗Avastin后增生性糖尿病视网膜病变（PDR）患者血清中血管内皮细胞生长因子（VEGF）的变化。方法收集玻璃体腔注射Avastin后PDR患者血清样本（注射前当天,注射后1 d,注射后7 d,注射后28 d）,并以注射前当天的血清样本为基准值作为对照,用ELISA方法测定血清中VEGF的含量。结果玻璃体腔注射Avastin术后,所有样本血清中VEGF含量都降低,降低幅度在术后7 d达到最大峰值,术后28 d VEGF有所上升,但仍未达到术前水平。结论一次玻璃体腔注射Avastin术后,血清中VEGF含量降低并且维持相当时间,说明Avastin进入到血液循环中,因此有必要密切关注Avastin玻璃体腔注射后的系统性影响和对未注射眼的影响。     

贝伐单抗玻璃体腔注射对PDR伴玻璃体积血的治疗效果

目的：观察玻璃体内注射贝伐单抗对增殖性糖尿病视网膜病变( proliferative diabetic retinopathy, PDR )伴玻璃体积血的治疗效果。
　　方法：选择2013-01/2015-08于我院诊断为PDR伴玻璃体积血的患者共46例50眼,其中28例30眼接受贝伐单抗治疗,设为注药组;另外18例20眼作为对照组,对照组除未接受贝伐单抗注射外其他治疗方法及随诊等均同注药组。观察记录两组患者4 wk 后玻璃体积血吸收情况、术后最佳矫正视力、玻璃体再出血等情况。对于两组患者,贝伐单抗注射后每周随访,若出血吸收,眼底可看清,则及时行荧光素眼底血管造影及视网膜激光治疗;注药后4wk,若玻璃体积血无明显吸收或积血加重者,或随访过程中出现视网膜牵引脱离者,则及时行玻璃体切除术(pars plana vitrectoly,PPV),随诊时间3lo。
　　结果：随访3 lo后,两组患者共避免玻璃体切除术10眼,其中注药组9眼(30%),对照组1眼(5%),两组间比较差异有统计学意义(χ2=6.108, P=0.0171)。随访3 lo后注药组视力提高19眼(63%),对照组视力提高7眼(35%),组间比较差异有统计学意义(χ2=6.102,P=0.014)。两组患者中共40眼行玻璃体切除手术,注药组21眼中有5眼玻璃体腔硅油填充(24%),对照组19眼中有12眼玻璃体腔硅油填充(63%),硅油填充眼数比较差异有统计学意义(χ2=5.2849,P=0.0137)。
　　结论：贝伐单抗玻璃体腔注射后可以使部分PDR伴玻璃体积血患者避免玻璃体切除手术,降低手术难度,减少眼内硅油填充率和术后再出血,提高术后视力。     

玻璃体腔内注射曲安奈德与贝伐单抗治疗白内障术后黄斑水肿的疗效

目的：：评价曲安奈德和贝伐单抗玻璃体腔注射治疗白内障术后黄斑水肿的疗效,为临床安全有效用药提供参考。方法：选择2012-03/2014-03在我院眼科确诊为黄斑水肿的患者92例92眼为研究对象,按照玻璃体腔注射用药不同,分为曲安奈德组44例44眼和贝伐单抗组48例48眼,术后随访9mo,比较两组患者在不同时间点的最佳矫正视力、黄斑中央视网膜平均厚度和眼内压情况。结果：术后随访9mo,两组患者术后的最佳矫正视力均比术前提高,但组间无统计学意义(P>0.05);经重复测量方差分析,两组患者的黄斑中央视网膜厚度无统计学意义(P>0.05)。曲安奈德组术后各时间点与术前的黄斑中央视网膜厚度差异具有统计学意义( t=9.16,8.27,5.44,5.87,4.62,P<0.05),贝伐单抗组术后各时间点的斑中央视网膜厚度均比术前降低,具有统计学意义( t=8.11,5.12,4.16,3.27,2.88,P<0.05);曲安奈德组有7例患者发生眼压升高,并发为青光眼,贝伐单抗组患者未见眼压异常。结论：曲安奈德和贝伐单抗均可提高黄斑水肿患者的矫正视力,改善毛细血管的渗漏情况,但贝伐单抗不会引起眼压升高,能避免其他并发症的发生,安全性更高。     

贝伐单抗与曲安耐德玻璃体腔注射治疗糖尿病黄斑水肿近期疗效的比较

背景黄斑水肿是糖尿病最常见的损害视力的原因,玻璃体腔注射贝伐单抗和曲安奈德（TA）的方法已被用于糖尿病黄斑水肿（DME）的治疗,但2种药物的临床效果和安全性的评价和比较是非常必要的。目的评价和比较玻璃体腔注射贝伐单抗和TA治疗DME的疗效及安全性。方法收集经OCT及荧光素眼底血管造影（FFA）确诊为DME者98例98眼,按就诊的先后时间分为贝伐单抗组和TA组,每组各49例49眼。贝伐单抗组患眼于角膜缘后4mm处行玻璃体腔注射贝伐单抗0．05ml（1．25mg）,TA组玻璃体腔注射TA0．1ml（4mg）。术后4、8、12周观察并比较2组患眼的视力（国际视力表视力）、黄斑中心视网膜厚度（CMT）、眼压及并发症的情况。结果所有患者均完成临床试验。2组患者的人口基线特征比较差异均无统计学意义（P〉0．05）。TA组和贝伐单抗组患眼玻璃体注射后各时间点视力与注射前比较均明显提高,差异均有统计学意义（P〈0．01）,贝伐单抗组在治疗后4～8周时视力最好,注射12周时视力较8周下降,差异有统计学意义（t=-11．579,P〈0．05）;玻璃体注射前后不同时间2组患眼间的视力比较差异均无统计学意义（P〉0．05）。玻璃体注射前后不同时问2组患眼间的CMT值比较差异均无统计学意义（P〉O．05）,但TA组和贝伐单抗组患眼玻璃体注射后各时间点CMT值与注射前比较均明显减少,差异均有统计学意义（P〈O．01）。TA组患眼玻璃体注射后4、8、12周眼压值均明显高于贝伐单抗组,差异均有统计学意义（P〈0．05、P〈0．01）,TA组患眼玻璃体注射后4、8、12周眼压值均高于注射前基线值（P〈0．01）,贝伐单抗组4、8、12周眼压值与注射前比较差异无统计学意义（P〉0．05）。TA组患眼玻璃体注射后眼压升高的发生率14．3％。结论玻璃体腔注射贝伐单抗治疗DME与TA玻璃体注射相比均能提高视力,减轻黄斑水肿。TA显效时间较贝伐单抗快,但贝伐单抗安全性较好。     

贝伐单抗联合曲安奈德玻璃体腔内注射治疗DME的疗效

目的:探讨贝伐单抗联合曲安奈德玻璃体腔内注射治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的临床疗效。方法:将105例105眼DME患者随机分为贝伐单抗联合曲安奈德组、单纯曲安奈德组和单纯激光组各35例35眼,三组分别采用玻璃体腔内注射贝伐单抗联合曲安奈德注射液、玻璃体腔内注射曲安奈德注射液和多波长激光光凝的不同治疗方法。结果:所有患者在治疗后均进行6mo的随访,根据患者视力、眼压、裂隙灯、FFA和OCT等检查结果进行疗效判定。激光组中,显效12例(34.3%),有效14例(40.0%),无效9例(25.7%),总有效率74.3%。曲安奈德组中,显效15例(42.9%),有效18例(51.4%),无效2例(5.7%),总有效率94.3%。贝伐单抗联合曲安奈德组中,显效23例(65.7%),有效12例(34.3%),没有无效病例,总有效率100%。经统计学处理,贝伐单抗联合曲安奈德组的有效率高于曲安奈德组和激光组,差异均具有统计学差异(P<0.05,P<0.01),贝伐单抗联合曲安奈德组和曲安奈德组的总有效率均显著高于激光组(P<0.01,P<0.01),贝伐单抗联合曲安奈德组和曲安奈德组之间的总有效率相比较,无统计学差异(P>0.05)。结论:贝伐单抗联合曲安奈德玻璃体腔内注射治疗DME的临床疗效显著,值得进一步研究和应用。     

玻璃体腔内注射贝伐单抗对增生性糖尿病视网膜病变玻璃体手术的影响

目的:评估术前1wk玻璃体腔内注射贝伐单抗对增生性糖尿病视网膜病变(PDR)玻璃体手术(PPV)的效果。方法:对46例PDR患者进行回顾性研究,46例患者随机分为玻璃体手术(PPV)组(n=28)和IVB组(n=18,PPV术前注射贝伐单抗)。玻璃体术前1wk注射贝伐单抗,比较两组间视力,医源性视网膜裂孔发生率,术中和术后出血情况。结果:术后1mo,PPV组和IVB组视力都明显提高(82.1%对88.9%)(P<0.01),两组间并无明显差异。医源性视网膜裂孔发生率PPV组18例,IVB组4例(64.3%对22.2%)(P<0.05)。术中出血PPV组28例,IVB组7例(100%对39%)(P<0.01),术后出血PPV组9例,IVB组0例(32.1%对0)(P<0.01)。结论:术前注射贝伐单抗可以减少增生性糖尿病视网膜病变玻璃体手术中医源性视网膜裂孔、术中出血和术后出血发生率。     

Intravitreal bevacizumab (Avastin®) in proliferative diabetic retinopathy

Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab in proliferative diabetic retinopathy (PDR) patients. Methods: This interventional case series study included 15 eyes of 10 patients with bilateral PDR: 13 eyes with severe PDR and active new vessels (NV) and two eyes with recurrent vitreous haemorrhages. Study eyes received a single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. All eyes were followed up for 3 months, and eight of them for 9 months. Reinjection was performed in three eyes 4–6 months after the first injection. Study eyes were evaluated by fluorescein angiography at baseline, 1, 3 and 9 months. Quantitative planimetric analysis (QPA) of NV area was measured before and after treatment. All eyes received or completed panretinal photocoagulation (PRP) 1 month after the first injection. Results: As early as at 1 month, all study eyes had a regression (paired t‐test, P = 0.01) of QPA‐estimated NV area. The eyes with recurrent vitreous haemorrhages had clearing of bleeding. These early effects were maintained at 3 months for all eyes and tended to be stable at 9 months. The fast and measurable efficacy of bevacizumab allowed a subsequent complete and safe PRP. Conclusion: Intravitreal bevacizumab did not reveal any side‐effects and was effective in the regression of NV areas and the resolution of vitreous haemorrhages. This approach is potentially useful in allowing (within a planned temporal window) a safe and efficient PRP to be performed while minimizing the risk of its complications.     

532nm激光治疗DR患者后视力和黄斑水肿的情况分析

目的:分析532nm激光治疗糖尿病视网膜病变(diabetic retinopathy,DR)患者的临床疗效.方法:选择本院2015-01/2016-12收治的DR患者100例136眼,均行532nm激光治疗,统计治疗后视力变化和并发症发生率,比较治疗前后黄斑中心凹视网膜厚度、患眼血流动力学变化情况,并比较分析不同糖尿病类型、DR分期、糖化血红蛋白(HbA1c)患者激光治疗效果.结果:与治疗前比较,患者治疗后黄斑中心凹视网膜厚度、舒张末期血流速度(end diastolic velocity,EDV)、搏动指数(pulsatility index,PI)、视网膜中央动脉(central retinal artery,CRA)、平均血流速度(mean flow velocity,Vm)均显著降低,差异有统计学意义(P<0.05);治疗后发生出血、牵拉性视网膜脱离各2例2眼;视力改善113眼(有效率83.1%),不同糖尿病类型(1型60.0% vs 2型84.9%)、DR分期(增殖前期92.3%,早期增殖期85.1%,高危PDR 54.2%)、HbA1c水平(<8%者91.8% vs ≥8%者73.0%)DR患者视力改善有效率比较,差异均有统计学意义(P<0.05).结论:532nm激光治疗DR疗效较好,能明显改善患眼视网膜血流动力学、视力和黄斑水肿,同时糖尿病分型、DR分期和血糖控制水平可能影响激光治疗效果.     

Panretinal photocoagulation versus panretinal photocoagulation plus intravitreal bevacizumab for high-risk proliferative diabetic retinopathy

AIM: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal bevacizumab (IVB) in patients with high-risk proliferative diabetic retinopathy (PDR) according to the Early Treatment Diabetic Retinopathy Study criteria. METHODS: The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP, the eyes were randomly assigned to receive only PRP (PRP group) or PRP plus intravitreal injection of 1.25 mg of bevacizumab (PRP-Plus group). Patients underwent complete ophthalmic evaluation, including best corrected visual acuity (BCVA), intraocular pressure (IOP), and new vessel size in fluorescein angiography (FA) and optical coherence tomography for the assessment of central subfield macular thickness (CSMT) at baseline and at weeks 12 (±2), 16 (±2), 24 (±2) and 48 (±2). Main outcome measures also included vitreous clear-up time and neovascularization on the disc (NVD) regression time. Adverse events associated with intravitreal injection were investigated. RESULTS: Thirty consecutive patients (n=36 eyes) completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations (NVs), BCVA or CSMT at baseline. The mean vitreous clear-up time was 12.1±3.4wk after PRP and 8.4±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group (P<0.05). Patients received an average of 1.3 injections (range: 1-2). Ten eyes (27.8%) underwent 2 injections. Two eyes had ocular complication of PDR progression to dense vitreous hemorrhage (VH). No major adverse events were identified. CONCLUSION: The adjunctive use of IVB with PRP is associated with a greater reduction in the area of active leaking NVs than PRP alone in patients with high-risk PDR. Short-term results suggest combined IVB and PRP achieved rapid clearance of VH and regression of retinal NV in the treatment of high-risk PDR. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.     

DR患者玻璃体切割术后黄斑水肿的治疗

目的:观察增生性糖尿病视网膜病变（proliferative diabetic retinopathy, PDR)玻璃体切割术后球周注射曲安奈德（triamcinolone acetonide, TA)联合黄斑区补充光凝治疗黄斑水肿的临床疗效。方法:PDR患者43例行玻璃体切割术及眼内全视网膜光凝术毕球周注射TA 40mg/mL,术后1wk选择有黄斑水肿患者32例,术后2wk行黄斑区补充532nm激光,术后1wk;1,3,6mo随访最佳矫正视力（best-corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度（central macular thickness, CMT)、并发症。结果:术后1mo视力提高28例（88%),视力不变4例（12%）,与术后1wk比较差异有显著性（P< 0.05）;术后3,6mo检查BCVA变化不大,与术后1mo比较均无显著性差异（P>0.05）;术后1wk CMT明显增厚,术后1mo黄斑水肿均不同程度减轻,与术后1wk比较差异有显著性（P<0.05）,术后3,6mo CMT变化不大,与术后1mo比较均无显著性差异（P> 0.05）。所有患者术后反应较轻,未出现严重并发症。结论:术后球周注射TA与黄斑区补充光凝结合起来治疗PDR患者术后糖尿病黄斑水肿取得了满意持久的临床效果。     

增生性糖尿病视网膜病变弥漫性黄斑水肿的激光治疗

目的　评价全视网膜光凝联合黄斑格栅样光凝治疗伴有弥漫性黄斑水肿的增生性糖尿病视网膜病变的疗效。方法　 4 0例 5 0眼伴有弥漫性黄斑水肿的增生性糖尿病视网膜病变患者 ,采用氩绿激光进行黄斑格栅样光凝联合全视网膜光凝。分析视力、黄斑水肿和新生血管的变化。结果　激光治疗后随访 6～ 30个月 ,5 0眼中 36眼治疗有效 ;76 %患眼的视力稳定 ,视力进步者占 12 % ;6 2 %患眼黄斑水肿明显减少 ,黄斑水肿完全消退者占 10 % ;视网膜新生血管或视盘新生血管完全消退者为 12 % ,部分消退者为 5 6 % ,余 14眼 (2 8% )治疗无效。结论　全视网膜光凝联合黄斑格栅样光凝是治疗伴有弥漫性黄斑水肿的增生性糖尿病视网膜病变的有效措施。     

贝伐单抗联合全视网膜光凝治疗增生型糖尿病视网膜病变的疗效观察

目的　检测贝伐单抗玻璃体内注射疗法（ｂｅｖａｃｉｚｕｍａｂｉｎｊｅｃｔｉｏｎｓｉｎｖｉｔｒｅｏｕｓ,ＩＶＢ）对增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａ-ｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）中视网膜新生血管（ｒｅｔｉｎａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＲＮＶ）的消退作用;评估ＩＶＢ联合全视网膜光凝（ｐａｎ-ｒｅｎｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）对ＰＤＲ的临床疗效和安全性。方法　本研究收集行ＰＲＰ的ＰＤＲ患者７２例（７２眼）,根据术前是否ＩＶＢ分为注射组和对照组,注射组在完成ＩＶＢ１．２５ｍｇ后第７天行眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查,并于当天开始第一个象限的ＰＲＰ,每周１次,共４次完成ＰＲＰ;对照组每周１次,共４次完成ＰＲＰ。两组患者均于ＰＲＰ后４周、８周、１２周复诊,并复查最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、眼压、ＦＦＡ、光学相干断层扫描、眼前节及眼底。结果　注射组ＩＶＢ后１周,ＢＣＶＡ提高,ＲＮＶ渗漏面积减少,与治疗前差异有统计学意义（Ｐ＜０．０５）;注射组各时间点ＢＣＶＡ、ＲＮＶ消退情况均显著优于对照组（均为Ｐ＜０．０５）。注射组各时间点黄斑中心凹视网膜厚度均较治疗前显著下降（均为Ｐ＜０．０５）,对照组各时间点黄斑中心凹视网膜厚度均较治疗前显著降低（均为Ｐ＜０．０５）,两组之间各时间点比较,差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＰＲＰ能延迟单纯ＩＶＢ后ＲＮＶ的复发;联合治疗可更有效地推动ＰＤＲ中ＲＮＶ消退,安全可靠,可以更好地保护患者的视觉功能。     

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Purpose

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP).

Methods

Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH.

Results

Eighteen eyes of 18 patients, mean age 47.7±12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6±0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient.

Conclusion

IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.     

Decreased prothrombin time after intravitreal bevacizumab in the early period in patients with proliferative diabetic retinopathy

Purpose: To evaluate the effect of intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA, USA) (IVB) injection on prothrombin time (PT) in patients with proliferative diabetic retinopathy (PDR) and nondiabetic patients. Methods: Eighty‐nine patients received primary IVB (1.25 mg) in one eye were investigated. The patients were divided into three groups: 34 PDR (diabetic group), 26 nondiabetic (nondiabetic group) patients received IVB and 29 PDR patients without IVB (control group). The levels of PT were detected before and after IVB in study groups and at corresponding time‐points in the control group. Paired samples t‐test was conducted to compare the statistical differences of PT in each group. Results: Significant difference (p < 0.001) of the levels of PT before and after IVB was observed in diabetic group in the early period, and the PT changes (11.0 ± 0.56 before and 10.6 ± 0.45 after IVB) were in fact within the normal range. There were no significant differences in other groups and other time‐points (all p > 0.05). Conclusions: Intravitreal bevacizumab may lead to a decrease in the levels of PT in the early period after IVB in PDR patients, suggesting a temporarily potential effect of IVB on the extrinsic clotting pathway of blood coagulation cascade in diabetic patients.