玻璃体内注射贝伐单抗和贝伐单抗/曲安奈德联合用药治疗糖尿病性黄斑水肿疗效及安全性差异的荟萃分析

目的综合评价玻璃体内注射贝伐单抗(IVB)和贝伐单抗/曲安奈德联合用药(IVB/IVT)两种方案治疗糖尿病性黄斑水肿的疗效与安全性的差异。方法检索Medline(1966～2011年)、EMbase(1966～2010年)、Cochrane图书馆(2010年)及中国生物医学文献数据库CBM(1979～2010年)有关贝伐单抗和贝伐单抗/曲安奈德联合用药对比治疗糖尿病性黄斑水肿的临床对照研究文献资料。采用Cochrane系统评价的方法 ,按照纳入和排除标准限定,通过Jadad评分量表进行文献质量评估后,使用RevMan5.1统计软件进行Meta分析,以获得二者治疗糖尿病性黄斑水肿的疗效及安全性是否有差异的相关证据。结果本研究纳入IVB和IVB/IVT对比治疗糖尿病性黄斑水肿的临床对照研究共4篇(321眼)。Meta分析结果显示,IVB组与IVB/IVT组患者的中央黄斑厚度降低幅度的差异为-28.72μm(95%CI,-90.68～33.25μm),差异无统计学意义(P=0.36);最佳矫正视力(以LogMAR视力计算)提高幅度的差异为-0.03(95%CI,-0.14～0.09),差异也无统计学意义(P=0.65)。IVB/IVT治疗组发生不良反应的比例是单纯IVB治疗组的2.44倍(95%CI,1.28～4.55倍),差异有显著统计学意义(P=0.006)。结论两种方案治疗糖尿病性黄斑水肿时,在降低中央黄斑厚度和提高最佳矫正视力方面疗效相仿;而单纯IVB治疗的安全性优于IVB/IVT联合治疗,但尚需更多前瞻性大样本的临床随机对照试验数据支持。     

首选玻璃体腔注射贝伐单抗与曲安奈德对比治疗糖尿病性黄斑水肿疗效及安全性差异的荟萃分析

目的 综合评价玻璃体腔注射贝伐单抗（IVB）与曲安奈德（IVT）治疗糖尿病性黄斑水肿（DME）的疗效与安全性差异。设计 荟萃分析。 研究对象 Medline（1966~2011年）、EMbase（1966~2010年）、Cochrane图书馆（2010年）及中国生物医学文献数据库CBM（1979~2010年）有关贝伐单抗与曲安奈德对比治疗DME的临床对照研究文献。 方法 采用Cochrane系统评价方法检索文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得二者治疗DME的疗效及安全性是否有差异的相关证据。 主要指标 中央黄斑厚度,最佳矫正视力,不良反应。 结果 共纳入IVB与IVT对比治疗DME的临床对照研究7项（共417眼）。首选IVB组与首选IVT组的患者中央黄斑厚度降低幅度的差异为-55.34 μm（95%CI： -104.51 ~ -6.17 μm,P=0.03）;提高最佳矫正视力幅度的差异为-0.06（95%CI： -0.13~0.00,P=0.06）。首选IVT组发生眼压升高的比例是首选IVB组的14.3倍（95%CI： 4~50倍,P=0.000）。 结论 IVT治疗DME在降低中央黄斑厚度方面优于IVB,在提高视力方面二者相似,但安全性方面较IVB差。二者谁更适合作为DME的首选治疗,尚需更多前瞻性大样本临床随机对照试验支持。（眼科,2012,21：60-64）     

Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled,randomized clinical trial

Purpose To evaluate the effect of three intravitreal injections of bevacizumab (IVB) alone or combined with triamcinolone (IVT) in the first injection for treatment of refractory diabetic macular edema (DME). Methods In this prospective, placebo-controlled, randomized clinical trial, 115 eyes of 101 patients with refractory DME were included. Subjects were randomly assigned to one of the three study arms: 1) three injections of IVB (1.25 mg/0.05 ml) at 6-week intervals, 2) combined IVB and IVT (1.25 mg/0.05 ml and 2 mg/0.05 ml respectively) followed by two injections of IVB at 6-week intervals, and 3) sham injection (control group). The primary outcome measure was change in central macular thickness (CMT). Secondary outcome measures were change in best-corrected logMAR visual acuity (BCVA ) and incidence of potential adverse events. Results Central macular thickness was reduced significantly in both the IVB and IVB/IVT groups. At week 24, CMT change compared to the baseline was −95.7 μm (95% CI, −172.2 to −19.26) in the IVB group, −92.1 μm (95% CI, −154.4 to −29.7) in the IVB/IVT group, and 34.9 μm (95% CI, 7.9 to 61.9) in the control group. There was a significant difference between the IVB and control groups (P = 0.012) and between the IVB/IVT and control groups (P = 0.022). Improvement of BCVA was initiated at weeks 6 and 12 in the IVB/IVT and IVB groups respectively. In terms of BCVA change compared to the baseline at 24 weeks, the differences between the IVB and control groups (P = 0.01) and also between the IVB/IVT and control groups (P = 0.006) were significant. No significant differences were detected in the changes of CMT and BCVA between the IVB and IVB/IVT groups (P = 0.99). Anterior chamber reaction was noticed in eight (19.5%) and seven (18.9%) eyes respectively in the IVB and IVB/IVT groups the day after injection, and it resolved with no sequel. Elevation of IOP occurred in three eyes (8.1%) in the IVB/IVT group. Conclusion Three consecutive intravitreal injections of bevacizumab had a beneficial effect on refractory DME in terms of CMT reduction and BCVA improvement. Addition of triamcinolone in the first injection seemed to induce earlier visual improvement; however, it did not show any significant additive effect later during follow-up. The 6-week result of this study was presented as a paper at the Annual Meeting of American Academy of Ophthalmology, November 2006, Las Vegas, NV, USA. The authors have no proprietary interest in this study. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request. Clinical Trial registration reference number: NCT00370422 (ClinicalTrials.gov).     

首选玻璃体腔注射贝伐单抗与曲安奈德对比治疗视网膜分支静脉阻塞继发黄斑水肿疗效及安全性差异的荟萃分析

目的 综合评价玻璃体腔注射贝伐单抗（IVB）与玻璃体腔注射曲安奈德（IVT）对比治疗视网膜分支静脉阻塞（BRVO）继发黄斑水肿时的疗效与安全性的差异。 设计 荟萃分析（Meta分析）。研究对象 Medline（1966-2012年）、EMbase（1966-2011年）、Cochrane图书馆（2011年）及中国生物医学文献数据库（CBM）（1979-2011年）有关贝伐单抗与曲安奈德对比治疗BRVO继发黄斑水肿的临床对照研究文献资料。 方法 采用Cochrane系统评价的方法,检索上述文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得两种治疗BRVO继发黄斑水肿的疗效及安全性是否有差异的相关证据。 主要指标 中央黄斑厚度（CMT）,最佳矫正视力（BCVA）,不良反应。 结果 共纳入IVB与IVT对比治疗BRVO继发黄斑水肿的临床对照研究8项（共376眼）。Meta分析结果显示,首选IVB组与首选IVT组的患者CMT降低幅度的差异为12.76 μm（95%CI,-7.74 ~ 33.26 μm,P=0.22）;提高BCVA幅度的差异为0.11 （95%CI,-0.00~0.23,P=0.06）。首选IVT组发生不良反应的比例是首选IVB组的20倍（95%CI,8.3~50倍,P=0.000）。 结论 采用首选IVB与IVT对比治疗BRVO继发黄斑水肿时,在降低CMT及提高BCVA方面两者疗效相仿,但安全性方面IVT明显较IVB差。二者间谁更适合作为BRVO继发黄斑水肿的首选治疗,尚需更多前瞻性大样本的临床随机对照试验数据支持。（眼科,2013,22：62-66）     

首选玻璃体腔注射贝伐单抗或曲安奈德对比治疗视网膜中央静脉阻塞继发黄斑水肿疗效及安全性差异的荟萃分析

目的 综合评价首选玻璃体腔注射贝伐单抗（IVB）或曲安奈德（IVT）对比治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿时的疗效与安全性的差异。 设计 荟萃分析。 研究对象 Medline（1966~2012年）、EMbase（1966~2011年）、Cochrane图书馆（2011年）及中国生物医学文献数据库CBM（1979~2011年）有关贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究文献资料。方法 采用Cochrane系统评价的方法,检索上述文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得二者治疗CRVO继发黄斑水肿的疗效及安全性是否有差异的相关证据。 主要指标 中央黄斑厚度（CMT）,最佳矫正视力,不良反应。 结果 共纳入玻璃体腔注射贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究6项（共242眼）。Meta分析结果显示,首选IVB组与首选IVT组的患者CMT降低幅度的差异为-33.22 μm（95%CI： -74.85 μm~8.42 μm）（P=0.12）,提高BCVA幅度的差异为0.01 （95%CI： -0.13~0.14）（P=0.92）。首选IVB发生不良反应的比例低于首选IVT（合并比值比为0.03, 95%CI： 0.01~0.10）。结论 采用首选IVB与IVT对比治疗CRVO继发黄斑水肿时,在降低CMT及提高BCVA方面二者疗效相仿,但安全性方面IVT明显较IVB差。二者间谁更适合作为CRVO继发黄斑水肿的首选治疗,尚需更多前瞻性大样本的临床随机对照试验数据支持。     

糖尿病性黄斑水肿联合治疗的临床观察

目的:评价玻璃体腔注射曲安奈德(IVTA)联合视网膜激光对糖尿病性黄斑水肿(DME)的疗效.方法:将黄斑部出现微血管瘤的DME患者25例(32眼)随机分为A、B、C、D组,每组8眼.A组行单纯倍频532激光光凝治疗,B组行倍频532激光光凝联合经瞳孔温热疗法,C组行倍频532激光光凝联合曲安奈德玻璃体腔注射治疗,D组行倍频532激光光凝、经瞳孔温热疗法加曲安奈德玻璃体腔注射治疗,C、D组在激光治疗后1周行玻璃体腔注射曲安奈德4 mg.观察4组治疗前及治疗后1、3、6个月视力、眼压、黄斑中心凹厚度(FT).结果:4组患者治疗前视力、眼压、黄斑中心凹厚度差异均无统计学意义(P＞0.05):4组治疗后1、3、6个月,视力、眼压、黄斑中心凹厚度:A组与B组、C组与D组差异无统计学意义(P＞0.05),A、B组分别与C、D组比较差异有统计学意义(P＜0.05).结论:激光联合曲安奈德玻璃体注射、激光、经瞳孔温热疗法联合曲安奈德玻璃体腔注射治疗DME效果优于单纯激光和激光联合经瞳孔温热疗法.     

Diabetic macular edema before and after intravitreal triamcinolone injection

PURPOSE: To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. METHODS: In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) < 20/50 and central macular thickness (CMT) > 200 microm, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). RESULTS: Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52+/-50 microm increase after sham vs. 262+/-115 microm reduction after IVT) was significant (P=0.014). CONCLUSIONS: Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.     

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 versus intravitreal bevacizumab for diabetic macular edema:a meta-analysis

AIM: To compare the efficacy of the sole intravitreal triamcinolone (IVT) versus intravitreal bevacizumab (IVB) alone or IVB combined with IVT in the treatment of diabetic macular edema (DME).METHODS: Pertinent publications were identified through systematic searches of database and manually searching. Methodological quality of the literatures was valuated according to the Jadad Score. RevMan 5.1.0 was used to do the meta-analysis. Heterogeneity was determined and sensitivity was conducted.RESULTS: Six studies were ultimately included in the meta-analysis. The results of our analysis showed IVT had a statistically significant improvement in vision over the IVB at 1 month and 3 months (P＜0.01＝. However, the reduction was not significant regarding central macular thickness (CMT) during the earlier (1 month and 3 months) follow-up period (P=0.12, P=0.41, respectively). At later visit (6 months), IVT had a significant decrease in CMT when compared to IVB (P＜0.01) while no significant improvement in visual acuity (VA) was observed (P=0.14). The incidence of intraocular hypertension was 13/102 in IVT group during follow-up period while 0/103 in IVB group. The difference was significant (P＜0.01). With regards to IVT versus IVB combined with IVT, there were no significant differences in CMT at 1 month (P=0.86) and 3 months (P=0.06). The incidence of intraocular hypertension was 6/67 in IVT group during follow-up period while 4/66 in IVB+IVT group. But the difference was not significant (P=0.53).CONCLUSION:Current evidence shows IVT is superior in improving VA at earlier follow-up (1 month and 3 months) and in reducing CMT at later follow-up (6 months) for DME. At other time, it is in favor of IVT treatment but there are no statistically significances. However, IVT has the side-effect of ocular hypertension. There is no adequate evidence of the benefit adding IVB to IVT in contrast to IVT alone.     

Comparison of intravitreal bevacizumab with macular photocoagulation for treatment of diabetic macular edema:a systemic review and Meta-analysis

AIM: To further evaluate the efficacy and safety of intravitreal bevacizumab (IVB) versus macular photocoagulation (MPC) in treatment of diabetic macular edema (DME) by Meta-analysis.METHODS: Pertinent publications were identified through systemic searches of PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register up to 30 November, 2013. Changes in central macular thickness (CMT) in μm and best-corrected visual acuity (BCVA) in logMAR equivalents were extracted at 1, 3, 6, 12 and 24mo after initial treatment, and a Meta-analysis was carried out to compare results between groups receiving IVB and MPC.RESULTS:Five randomized controlled trial (RCTs) and one high-quality comparative study were identified and included. Our Meta-analysis revealed that both IVB and MPC resulted in the improvements of CMT and BCVA in eyes with DME at 1mo after initial treatment, with IVB being significantly superior to MPC (P=0.01 and 0.02, respectively). The improvements of both measure outcomes at 3, 6, 12 and 24mo after treatment did not vary significantly between the IVB groups and MPC groups (CMT at 3mo, P=0.85; at 6mo, P=0.29; at 12mo, P=0.56; at 24mo, P=0.71; BCVA at 3mo, P=0.31; at 6mo, P= 0.30; at 12mo, P=0.23; at 24mo, P=0.52). However, the number of observed adverse events was low in all studies.CONCLUSION: Current evidence shows IVB treatment trends to be more effective in improvements of macular edema and vision in eyes with DME at an earlier follow up (1mo) compared with MPC. At other time, both interventions have comparable efficacy without statistical significances.     

Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema

PURPOSE: To compare the effect of an intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor (VEGF) antibody, with that of triamcinolone acetonide, a corticosteroid for reduction of diabetic macular edema (DME). DESIGN: Prospective, comparative interventional case series. METHODS: Twenty-eight eyes of 14 patients with bilateral DME participated in this study. In each patient, one eye received an intravitreal injection of 4 mg triamcinolone acetonide and the other eye received 1.25 mg bevacizumab. The clinical course of best-corrected visual acuity (VA) with a logarithm of the minimum angle of resolution chart and averaged foveal thickness using optical coherence tomography was monitored for up to 24 weeks after the injection. RESULTS: Before the injection, foveal thickness and VA were 522.3 +/- 91.3 microm and 0.64 +/- 0.28 microm in the triamcinolone-injected eye, and 527.6 +/- 78.8 microm and 0.61 +/- 0.18 microm in the bevacizumab-injected eye, respectively; there was no significant difference between the eyes. One week after the injection, both eyes showed significant regression of macular edema. The triamcinolone-injected eye (342.6 +/- 85.5 microm and 0.33 +/- 0.21 microm) showed significantly better results than the bevacizumab-injected eye (397.6 +/- 103.0 microm and 0.37 +/- 0.17 microm). However, both eyes showed the recurrence of macular edema with time, even at 24 weeks. Triamcinolone (410.4 +/- 82.4 microm and 0.47 +/- 0.25 microm) kept better results than bevacizumab (501.6 +/- 92.5 microm and 0.61 +/- 0.17 microm). CONCLUSIONS: With the generally used concentration, intravitreal injection of triamcinolone acetonide showed better results in reducing DME and in the improvement of VA than that of bevacizumab, suggesting that the pathogenesis of DME is not only attributable to VEGF-dependency, but is also attributable to other mechanisms suppressed by corticosteroid.     

黄斑格栅样激光光凝联合玻璃体腔注射曲安奈德治疗糖尿病性黄斑水肿的疗效分析

目的评价黄斑格栅样激光光凝联合玻璃体腔注射曲安奈德（IVTA）对糖尿病性黄斑水肿（DME）的治疗效果。方法将DME患者48例（60眼）分成A、B、C组,每组20眼,A组行单纯黄斑区格栅样激光光凝治疗,B组行单纯IVTA治疗,C组在IVTA4mg后2周行黄斑区格栅样激光光凝。观察3组治疗前及治疗后1、3、6个月的视力,黄斑中心凹厚度。结果3组患者治疗前视力、黄斑中心凹厚度差异均无统计学意义（P〉0．05）,3组治疗后1、3、6个月,视力、黄斑中心凹厚度比较：A组与B组差异无统计学意义（P〉0．05）,A、B组分别与C组比较差异有统计学意义（P〈0．05）。结论黄斑格栅样激光光凝联合IVTA优于单纯激光及单纯玻璃体腔注药。     

Intravitreal triamcinolone acetonide for diffuse diabetic macular oedema: 6-month results of a prospective controlled trial

PURPOSE: To evaluate prospectively the efficacy and safety of one intravitreal injection of 4 mg triamcinolone acetonide for refractory diffuse diabetic macular edema. METHODS: Seventeen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye was injected, and the other served as a control. The intervention consisted in intravitreal injection of 4 mg triamcinolone acetonide. The main outcome measure was central macular thickness (CMT) at 4, 12 and 24 weeks, measured by Optical Coherence Tomography. Secondary outcomes were Early Treatment Diabetic Rentinopathy Study (ETDRS) scores, intraocular pressure and cataract PROGRESSION. RESULTS: Before injection, mean +/- SD CMT was 566.4 +/- 182.4 mum in injected eyes. Four, 12, and 24 weeks after injection, it was 228.4 +/- 47.5 mum, 210.9 +/- 87.2 mum and 358.5 +/- 160.5 mum respectively. CMT was significantly lower in injected eyes vs. control eyes except 24 weeks after injection because of a recurrence of macular edema in 9/17 injected eyes. Mean +/- SD gain in ETDRS score was significantly better in injected eyes vs. control eyes 4, 12 and 24 weeks after TA injection. In 9 of the 17 injected eyes, intraocular pressure exceeded 24 mmHg and was controlled by topical medication. CONCLUSION: In the short-term, intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema and improves visual acuity in most cases. The long-term effect of this treatment and predictive factors of visual recovery remain to be elucidated.     

A randomized, placebo-controlled clinical trial of intravitreal triamcinolone for refractory diabetic macular edema

Purpose To evaluate the effect of intravitreal triamcinolone acetonide (IVT) on refractory diabetic macular edema (DME). Methods In a prospective, placebo-controlled, randomized clinical trial, 88 eyes of 61 patients with clinically significant macular edema that would have responded unfavourably to laser photocoagulation were randomly assigned to two groups. The treatment group (45 eyes) received 4 mg IVT and the control group (43 eyes) received a placebo subconjunctival injection. The primary outcome was central macular thickness (CMT) measured by optical coherence tomography. Complete examination was repeated at 2 and 4 months post-intervention. Results The mean (SD) CMT before the intervention and at the 2- and 4-month follow-ups was 393 (151), 293 (109) and 362 (119) μm in the treatment group and 393 (166), 404 (134) and 405 (160) μm in the placebo group, respectively. The second month difference was significant (P = 0.01). The difference between visual acuity changes (0.15 logarithm of the minimum angle of resolution, logMAR) was significant at 2 months (P = 0.02) but reduced to 0.11 logMAR (P = 0.08) after 4 months. Reduction for hard exudates and petaloid pattern were significantly greater in cases at 4 months. Conclusions The therapeutic effect of IVT on DME is greatest at 2 months and decreases up to the fourth month post-intervention. However, in terms of cystoid macular edema and hard exudates, the effect is maintained up to 4 months.     

Intravitreal bevacizumab alone or combined with 1 mg triamcinolone in diabetic macular edema: a randomized clinical trial

Purpose

To compare the results of intravitreal bevacizumab (IVB) injection alone or in combination with intravitreal 1 mg triamcinolone acetonide (IVT) in center-involved diabetic macular edema.

Methods

In this randomized clinical trial study, ninety-two eyes of 46 patients with bilateral center-involved diabetic macular edema and no previous treatment were included in the study. One eye of each patient was randomly assigned to 1.25 mg of IVB injection or combination of 1.25 IVB and 1 mg IVT. Evaluation of best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) and grading of lens opacity was conducted at baseline, and weeks 2, 4, 6, 8, 12 and 24 after treatment. Retreatment was performed at a 6-week interval whenever indicated based on CMT.

Results

Between the groups, BCVA changes were not statistically different until 24-week follow-up (P > 0.05), but at 24 weeks after treatment, BCVA improvement was significantly better in IVB group (P = 0.049). Significant CMT reduction was observed in each group along the follow-up period (P = 0.001). The mean CMT reduction was more significant in combination (IVB + IVT) group at 2 weeks of follow-up (P < 0.001), but CMT changes were not significant between the groups at weeks 12th and 24th after injection. Overall, retreatment was applied for 59 eyes up to 24 weeks (33 in the IVB group, 26 in the IVB + IVT group). Among patients with 2 or more injections, number of injections was significantly lower in IVB + IVT group (P = 0.043). Three eyes within IVB + IVT group developed IOP rise beyond 21 mmHg, which were controlled with topical anti-glaucoma medications within 1 week. Changes in lens opacity were not significant between two groups.

Conclusion

Eyes treated with IVB plus 1 mg IVT injections had more significant reduction in CMT in early post-injection, but this effect was transient. Although after 24 weeks visual acuity improvement was better in IVB group, combination therapy may decrease the number of injections. Combining 1 mg of intravitreal triamcinolone with bevacizumab was not accompanied with significant side effects.

     

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.     

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.     

Single-session photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration

PURPOSE: To evaluate the efficacy of combined single-session photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) for treatment of neovascular age-related macular degeneration (AMD). METHODS: In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) underwent PDT followed by 1.25 mg IVB injection. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were repeated at 6-week intervals and fluorescein angiography was performed after 12 weeks and when considered necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage. RESULTS: Fourteen eyes were included in this study. Mean follow-up was 52.4+/-15.2 weeks (range: 26-74 weeks). Initially, mean BCVA was 0.80+/-0.42 logMAR and mean central macular thickness (CMT) was 308+/88 microm. At week 12, BCVA improved to 0.62+/-0.47 logMAR (p=0.006) and CMT reduced to 186+/-53 microm (p=0.003). Corresponding results were 0.53+/-0.52 logMAR (p=0.02) and 193+/-78 microm (p=0.002) after 24 weeks. A second IVB injection was performed in 13 eyes with a mean interval of 16.3+/-5.9 weeks. CONCLUSIONS: Combination therapy with single-session PDT and IVB can improve vision and reduce CMT in neovascular AMD. Repeat IVB injections may maintain the visual gain from the initial combination therapy.     

玻璃体腔注射康柏西普联合黄斑区格栅样光凝治疗DME

目的:观察玻璃体腔注射康柏西普眼用注射液联合黄斑区格栅样光凝治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的临床疗效.方法:对DME患者(40例40眼)随机分成试验组和对照组,每组各20例20眼.两组均实施一次黄斑区格栅样光凝治疗,试验组分别在第1次激光时及相隔45d后行玻璃体腔注射康柏西普治疗,比较两组患者激光术后45、90d的黄斑水肿消退情况及视力改变情况.结果:试验组术后45d黄斑厚度为293.90±12.94μm,对照组术后45d黄斑厚度为320.20±29.17μm,两组差异有统计学意义(P<0.05);试验组术后90d黄斑厚度为265.80±16.26μm,对照组术后90d黄斑厚度为290.15±12.23μm,两组差异有统计学意义(P<0.05);试验组术后45d最佳矫正视力为0.40±0.08,对照组术后45d最佳矫正视力为0.34±0.04,两组差异有统计学意义(P<0.05);试验组术后90d最佳矫正视力为0.46±0.09,对照组术后90d最佳矫正视力为0.37±0.06,两组差异有统计学意义(P<0.05).结论:玻璃体腔注射康柏西普联合格栅样光凝治疗DME较单纯黄斑区格栅样光凝组能明显提高视力,减轻黄斑水肿,对于延长两次玻璃体腔注射康柏西普间隔时间是否可以更为科学,仍需进一步研究.     

Short-term Results of a Single Intravitreal Bevacizumab (Avastin) Injection versus a Single Intravitreal Triamcinolone Acetonide (Kenacort) Injection for the Management of Refractory Noninfectious Uveitic Cystoid Macular Edema

Purpose: To report the short-term results of a single intravitreal injection of bevacizumab (IVB) versus a single intravitreal injection of triamcinolone acetonide (IVT) to treat refractory noninfectious uveitic cystoid macular edema (CME).

Methods: Twenty-eight consecutive patients (36 eyes) were retrospectively included. Patients received either 2.5?mg of IVB (16 eyes) or 4?mg of IVT (20 eyes).

Results: In the IVT group, baseline best-corrected visual acuity (BCVA) was logMAR 1.1?±?0.2, and improved to 0.7?±?0.3 (p?<?.001) at 6 months. In the IVB group, baseline BCVA was logMAR of 1.2?±?0.4 and improved to 0.8?±?0.4 at 6 months (p?=?.031). At 6 months, central macular thickness (CMT) in the IVT group improved from 454.8?±?238.9?μm to 296?±?134.4?μm (p?<?.0001).

Conclusion: A single IVT injection improves BCVA and reduces CMT more effectively than IVB in refractory noninfectious uveitic CME at 6 months.