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.     

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.     

抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔单次注射后对侧眼缺血性视网膜病变一例

患者男,47岁.因右眼青光眼减压阀植入手术后1个月,发现右眼眼压升高1周于2011年5月30日入院.既往患2型糖尿病10余年,长期应用胰岛素治疗,血糖控制稳定,否认高血压、高度近视、血液病.2011年1月25日曾以“右眼牵拉性视网膜脱离,右眼增生性糖尿病视网膜病变,左眼中度非增生性糖尿病视网膜病变”在我院行右眼玻璃体切割手术联合视网膜激光光凝治疗.2011年4月25日因“右眼新生血管性青光眼”行右眼抗青光眼减压阀植入手术,手术后右眼视力手动/眼前,眼压维持在10.3～18.3 mm Hg(1 mm Hg=0.133 kPa).     

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.     

玻璃体腔注射曲安奈德治疗糖尿病性黄斑水肿

目的探讨玻璃体腔注射曲安奈德(intravitrealtriamcinoloneacetonide,IVTA)治疗糖尿病性黄斑水肿(diabeticmacularedema,DME)的疗效。方法回顾性分析25例(28只[)糖尿病性黄斑水肿患者,采用IVTA治疗,剂量为4mg/0.1ml。对比分析治疗前后视力,[压及黄斑区视网膜厚度变化。平均随访6个月。统计学方法采用SPSS13.0软件对各组数据进行处理(秩和检验、配对t检验)。结果治疗后1个月、3个月、6个月,平均视力由术前0.08±0.04分别提高到0.15±0.12、0.16±0.13、0.14±0.12,与治疗前比较差异有统计学意义(P<0.001)。OCT检查黄斑视网膜厚度术前平均为(599.89±135.65)μm,治疗后各时点分别为(249.70±74.69)μm、(243.18±73.19)μm和(245.54±69.33)μm。与治疗前比较有显著性差异(P<0.001)。5只[(17.9%)接受2次IVTA,第一、二次注药时间平均间隔为3个月。9只[(32.1%)[压升高(>21mmHg),局部或全身应用降[压药,[压均能控制正常。结论IVTA是治疗DME的有效方法,能有效改善黄斑水肿和提高视力,降低黄斑区视网膜厚度,但部分黄斑水肿复发,出现一过性[压升高,需进一步观察其长期疗效和安全性。     

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玻璃体腔注射治疗高度近视脉络膜新生血管的疗效观察

脉络膜新生血管(CNV)在近视眼的患病率约为5.0%～10.0%,在高度近视眼可达40.7%[1],是影响高度近视患者视功能的主要原因之一.抗血管内皮生长因子(VEGF)单克隆抗体Bevacizumab(Avastin)玻璃体腔注射治疗高度近视CNV已有文献报道[2,3],我们对一组高度近视CNV患者进行了Bevacizumab玻璃体腔注射,现将结果报告如下.     

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.     

抗血管内皮生长因子单克隆抗体Bevacizumab预防非肥胖糖尿病小鼠视网膜微血管增生

目的 观察抗血管内皮生长因子单克隆抗体Bevacizumab眼内注射对非肥胖糖尿病小鼠视网膜微血管增生的预防作用。 方法 选取30只非肥胖糖尿病小鼠，左眼为实验眼，右眼为对照眼。实验眼眼内注入1 μl Bevacizumab(25 mg/1 ml)溶液， 对照眼眼内注入等量生理盐水。分别在注射后1周，1、2个月时随机各选取10只鼠，取出双侧眼球，行视网膜微血管内皮细胞超微结构观察以及视网膜CD34和血管内皮生长因子（VEGF）免疫组织化学测定，计算机图像分析对比两组间阳性染色密度的差异。 结果 VEGF和CD34阳性表达均为棕黄色着色，CD34的染色定位在血管内皮细胞上。在注射后1周、1个月时，两组间VEGF表达比较，差异有统计学意义（t=21.6, t=13.5; P＜0.01 ）；注射后2个月时，两组间VEGF表达比较，差异无统计学意义（t=0.9, P＞0.05）。注射后1周时，两组间CD34表达比较，差异无统计学意义（t=1.3, P＞0.05）；注射后1、2个月时，两组间CD34表达比较，差异有统计学意义（t= 3.2, P＜0.01; t=2.7, P＜0.05）。注射后各时间段，视网膜血管内皮细胞的微观结构都未发生明显改变。 结论 Bevacizumab眼内注射可预防非肥胖糖尿病小鼠视网膜微血管的异常增生。 （中华眼底病杂志，2008，24：180-183）     

玻璃体腔注射抗血管内皮生长因子单克隆抗体Ranibizumab治疗脉络膜新生血管疗效观察

研究证实,血管内皮生长因子(VEGF)在脉络膜新生血管(CNV)血管形成过程中扮演重要的角色,因此VEGF已成为目前进行靶向治疗的主要目标.抗VEGF单克隆抗体Bevacizumab(Avastin)能直接阻断VEGF蛋白,眼内注射Ranibizumab能够有效抑制CNV[1-5].我们对本院接受玻璃体腔注射Ranibizumab治疗的一组CNV患者临床资料进行了回顾性分析,以评估中国人玻璃体腔内注射Ranibizumab治疗CNV的安全性和有效性.     

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 alone versus combined with macular photocoagulation in diabetic macular edema

Purpose

To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography.

Methods

The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared.

Results

In patients with the bevacizumab injection only, VA improved from 0.29 ± 0.18 to 0.48 ± 0.26 at 1 month and returned to 0.32 ± 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 ± 0.22 to 0.52 ± 0.26 at 1 month and returned to 0.36 ± 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type.

Conclusions

The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.     

玻璃体腔注射曲安奈德与Bevacizumab治疗视网膜静脉阻塞性黄斑水肿疗效比较

目的 比较玻璃体腔注射曲安奈德(TA)与抗血管内皮生长因子单克隆抗体(Bevacizumab)治疗视网膜静脉阻塞性黄斑水肿(RVOME)的临床疗效.方法 共116例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RVOME患者的116只眼纳入观察.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75例,Bevacizumab组41例,两组在术前年龄、病程、最佳矫正视力(BCVA)、中心视网膜厚度(CMT)方面均无显著差异.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 视力方面,与基线比较,TA组治疗后4周(P=0.000)、8周(P=0.000)、12周(P=0.000)时均有显著提高;Bevacizumab组治疗后4周(P=0.000)、8周(p=0.000)时显著提高,12周时有所回落(P=0.074).CMT方面,与基线比较,TA组治疗后4周(P=0.000)、8周(p=0.000)、12周(P=0.004)时,均有显著降低;Bevacizumab组治疗后4周(P=0.003)、8周(P=0.000)时显著降低,12周(P=0.205)时无显著差异.两组间比较,视力在4周(P=0.985)、8周(P=0.989)、12周(P=0.306)时均无显著差异;CMT在4周(P=0.075)、8周(P=0.453)、12周(P=0.583)时均无显著差异.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RVOME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.     

Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome

Purpose

To compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema.

Bevacizumab玻璃体内注射治疗新生血管性年龄相关性黄斑变性

目前关于bevacizumab玻璃体内注射治疗新生血管性年龄相关性黄斑变性的临床研究表明,短期内患者耐受性良好,无严重眼部和全身性副作用,视网膜形态和功能均有明显改善。虽然Bevacizumab玻璃体内注射剂量很小,全身性副作用少,但目前缺乏有关安全性及有效性的前瞻性随机对照研究,建议使用时必须十分谨慎。     

Intravitreal bevacizumab injection for recurrent vitreous haemorrhage after diabetic vitrectomy

Purpose: To evaluate the efficacy of intravitreal bevacizumab in treating recurrent vitreous haemorrhage (VH) after diabetic vitrectomy. Methods: Consecutive patients with postoperative recurrent VH ≥ 2 weeks after primary diabetic vitrectomy were treated with intravitreal bevacizumab. Repeated injection was given after 2–3 weeks in case of no obvious blood reabsorption (study group). Consecutive patients with the same complication but without bevacizumab injection served as the control group. Vitreous surgeries in both groups were indicated if no clinical improvement was noted 10–12 weeks after the initial bleeding. Vitreous clear‐up time (VCT), vitreous surgeries and rebleeding rates, and visual acuity changes were compared between both groups. Results: The study group had 20 eyes (20 patients) and the control group had 18 eyes (18 patients). Postoperative VH occurred between 1 and 25 months and between 1 and 18 months, respectively. In the study group, VCT after the first recurrent VH was 6.5 ± 1.5 weeks with 2.2 ± 0.8 injections. Nine cases had ≥ one episode of VH, but no surgery was needed. In the control group, 13 eyes had spontaneous re‐absorption (in 6.4 ± 1.3 weeks); five eyes underwent surgeries; three of the 13 eyes eventually had surgeries after further recurrent VH. The rate of vitreous surgery in the two groups was 0/20 and 8/18 (p = 0.01). The total number of rebleeding was 30 in the study group and 27 in the control group (p = 0.69). Conclusion: Intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous haemorrhage after diabetic vitrectomy.     

Intravitreal bevacizumab treatment for refractory diabetic macular edema

To evaluate the effect of intravitreal bevacizumab (IVB) on visual function and retinal thickness in patients with refractory diabetic macular edema (DME). Eyes with DME treated with IVB which were resistant to different previous treatments were enrolled in this retrospective, non-randomized series study. Each patient underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), slit-lamp examination, intraocular pressure measurement, fundus examination, retinal thickness measurement with optic coherence tomography at baseline and at each visit. Digital fundus fluorescein angiography was performed at baseline for each patient. A total of 71 eyes of 59 patients (36 male and 23 female) were included in the study. All eyes had focal laser photocoagulation (71 eyes, 100 %) and had one other additional treatment including an intravitreal (23 eyes, 32 %) or subtenon (18 eyes, 25 %) injection of triamcinolone acetonide. The mean follow-up period was 9.79 ± 8.6 months and the mean number of IVB treatments was 2.01 ± 1.06 (min–max, 1–4). Mean logMAR BCVA was 0.88 ± 0.4 at baseline, 0.78 ± 0.4 at 4 weeks and 0.79 ± 0.4 at the last visit (p = 0.036). The mean central foveal thickness was 515.4 ± 150.3 μm at baseline which significantly decreased to 367.01 ± 166.6 μm at 4 weeks (p = 0.0001) and 338.1 ± 159.7 μm at the last visit (p = 0.0001). Sixteen percent of the eyes did not respond to IVB treatment. IVB treatment for refractory DME seems to be effective and safe and repeated treatments are necessary for a significant portion of the cases.     

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。     

Intravitreal injection of bevacizumab and gas for diabetic premacular hemorrhage with active fibrovascular proliferation

Background  To report the effect of intravitreal injection of bevacizumab and gas for the treatment of diabetic premacular hemorrhage with active fibrovascular proliferation. Methods  Six eyes of six consecutive patients with acute diabetic premacular hemorrhage and active fibrovascular proliferation received intravitreal injection of bevacizumab (1.25 mg in 0.05 mL) and C3F8 (0.2–0.3 mL) during the same setting. All six cases had panretinal photocoagulation prior to the procedure. After treatment, patients maintained a prone position for 3 days and were followed for an average of 8 months (range, 4–13 months). Results  All six eyes had complete reabsorption of the hemorrhage and reduction of fibrovascular proliferation. Transient vitreous opacification from breakthrough of the blood were observed in all eyes. An average of 3.8 weeks (range, 1–6 weeks) was required for the clearing of preretinal hemorrhage. Visual acuity improved in all six eyes. No recurrent bleeding or other adverse events were encountered in all cases. Conclusions  Intravitreal injection of bevacizumab and gas may be an effective method for treating acute diabetic premacular hemorrhage with active fibrovascular proliferation. The authors do not have any proprietary interests in the material used in this study. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data upon request. ClinicalTrials.gov ID: NCT00673296. The study was approved by the institutional research board of National Taiwan University Hospital (NTUH-REC No. 200711050R).     

玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管

目的探讨玻璃体腔注射贝伐单抗(Bevacizumab,Avastin)治疗特发性脉络膜新生血管(idiopathic choroidal neovascu-larization,ICNV)的疗效及安全性。方法对32例(32眼)ICNV患者行玻璃体腔注射Avastin1.25mg(0.05mL)。根据复查裂隙灯、眼底检查、光学相干断层扫描、眼底荧光素血管造影(fluorescence fundus angiography,FFA)及最佳矫正视力(best-correctedvisual acuity,BCVA)情况决定是否重复注射。对比观察治疗前后BCVA、黄斑中心凹厚度、眼压及FFA改变情况。结果治疗前BCVA为0.309±0.244,治疗2周后及末次复查时BCVA分别为0.477±0.223、0.670±0.245,差异有显著统计学意义(P<0.001);治疗前黄斑中心凹厚度为(383.280±110.797)μm,治疗2周后及末次复查分别为(296.360±87.850)μm、(264.000±82.978)μm,差异有显著统计学意义(P<0.001);治疗前FFA显示有CNV及荧光渗漏,治疗后新生血管萎缩,无荧光渗漏;治疗前后眼压差异无统计学意义(P>0.05),未发生眼内炎。结论 Avastin是一种安全、有效治疗ICNV的药物。