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.     

Comparison Between Intravitreal Bevacizumab and Triamcinolone for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose

To compare the effects of intravitreal bevacizumab to those of triamcinolone acetonide injection for the treatment of macular edema secondary to branch retinal vein occlusion.

Methods

This retrospective study included 50 eyes of 50 patients who received a single injection of intravitreal bevacizumab (1.25 mg/0.05 mL, 22 eyes) or triamcinolone acetonide (4 mg/0.1 mL, 28 eyes) as the only treatment for macular edema secondary to branch retinal vein occlusion; all patients had a post-injection follow-up duration of >24 weeks. Best corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) by optical coherence tomography were measured for up to 24 weeks after injection.

Results

BCVA was improved at 1, 4, 8,12 weeks post-injection in the bevacizumab group, and at 1, 4, 8 weeks post-injection in the triamcinolone group. No significant difference was found between the two groups except at 12 weeks. CMT decreased significantly within each group, and no significant difference between groups was found. In the bevacizumab group, no elevated IOP was observed, whereas IOP was significantly increased at 4, 8, and 12 weeks after triamcinolone injection; IOP was therefore significantly different between the two groups.

Conclusions

Intravitreal bevacizumab is a comparatively simple treatment method that can effectively improve BCVA and reduce CMT without ocular and systemic complications. Consequently, intravitreal bevacizumab injections may be useful as both an alternative and primary treatment for macular edema secondary to branch retinal vein occlusion.     

Intravitreal triamcinolone acetonide in patients with macular oedema due to central retinal vein occlusion

PURPOSE: To evaluate treatment of macular oedema due to central retinal vein occlusion (CRVO) with intravitreal triamcinolone acetonide. METHODS: In a prospective case series, 13 patients with macular oedema due to non-ischaemic CRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included assessment of best corrected visual acuity (BCVA) for distance and reading, measurement of intraocular pressure (IOP), fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and 1 week, 1 month, 3, 6 and 9 months postoperatively. RESULTS: Preoperative mean BCVA was 0.9 +/- 0.4 for distance vision and 1.0 +/- 0.3 for reading acuity, respectively. A significant improvement in distance VA (0.5 +/- 0.3, p < 0.001) and reading acuity (0.7 +/- 0.3, p = 0.03) was observed until 3 months and 6 months, respectively. Mean macular thickness was significantly reduced until 9 months postoperatively. CONCLUSION: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to CRVO. However, the significant effect was not permanent and persisted for a maximum of 6 months.     

Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty‐three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4‐mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25‐mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best‐corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow‐up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.     

Safety and efficacy of intraoperative intravitreal injection of triamcinolone acetonide injection after phacoemulsification in cases of uveitic cataract

PURPOSE: To evaluate the safety and efficacy of a single intraoperative intravitreal injection of triamcinolone acetonide after phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis. SETTING: Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This prospective randomized controlled study included 40 eyes (40 patients) with chronic idiopathic anterior uveitis or intermediate uveitis that had phacoemulsification with intraocular lens implantation. Twenty eyes received an intravitreal injection of triamcinolone acetonide (4 mg/0.1 mL) intraoperatively (triamcinolone acetonide group), and 20 received oral steroids (steroid group) postoperatively. Outcome measures were Early Treatment Diabetic Retinopathy Study best corrected visual acuity (BCVA), anterior chamber reaction, intraocular pressure (IOP) by applanation tonometry, and central macular thickness by optical coherence tomography. RESULTS: The mean BCVA (decimal) improved from a baseline of 0.13 +/- 0.14 to 0.64 +/- 0.32 in the triamcinolone acetonide group and from 0.05 +/- 0.06 to 0.61 +/- 0.36 in the steroid group (P = .74). There were no statistically significant differences between the 2 groups in postoperative anterior chamber reaction, IOP, or central macular thickness. Four patients in the triamcinolone acetonide group and 5 in the steroid group had recurrence of uveitis; 5 patients in the triamcinolone acetonide group had ocular hypertension. One patient in the triamcinolone acetonide group and 3 in the steroid group had cystoid macular edema postoperatively. CONCLUSION: A single intraoperative intravitreal injection of triamcinolone acetonide seemed to be a safe and efficacious route of steroid delivery during phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis and is recommended as a substitute for postoperative oral steroid administration.     

贝伐单抗治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿的短期疗效及影响因素分析

目的　观察玻璃体内注射贝伐单抗治疗视网膜中央静脉阻塞（central retinal vein occlusion,CRVO）继发黄斑水肿患者的临床特征及疗效,探讨对短期黄斑水肿恢复有影响的因素。方法　回顾性分析60例60眼CRVO继发黄斑水肿患者,采用玻璃体内注射贝伐单抗1.25 mg（0.05 mL）,必要时重复治疗,随访3个月观察患者最佳矫正视力（best-corrected visual acuity,BCVA）及黄斑中心视网膜厚度（central retinal thickness,CRT）改变。根据治疗后3个月时CRT恢复水平,分析患者的年龄、病程、基线视力、基线CRT、高血压及糖尿病、黄斑囊样水肿（cystoid macular edema,CME）或视网膜下液体（subretinal fluid,SRF）情况对黄斑水肿恢复的影响。结果　BCVA从基线（0.897±0.395）LogMAR提高到治疗后1个月的（0.616±0.350）LogMAR,并稳定持续至治疗后3个月（P＜0.001）,同时CRT从基线（721.2±180.8）μm降低到治疗后3个月的（392.1±185.4）μm（P＜0.001）。治疗后3个月56.7%的CME和超过90%的SRF均得到完全缓解。年龄和基线CRT低提示治疗后3个月时CRT恢复较好（P=0.036、0.037）。年龄大的患者（＞60岁）治疗后黄斑水肿消除更多（P=0.031）,治疗后3个月时CRT更低（P=0.003）。结论　玻璃体内注射贝伐单抗能有效提高BCVA并降低CRT。年龄大和基线CRT低提示治疗后3个月时CRT恢复较好。CRT的降低主要取决于CME是否消除,而与SRF无关。     

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。     

玻璃体腔内注射TA与雷珠单抗治疗CRVO继发黄斑水肿的对照研究

目的：比较曲安奈德(TA)与雷珠单抗(ranibizumab)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发黄斑水肿的的临床疗效及安全性。

方法：回顾性分析继发黄斑水肿的CRVO患者40例40眼。其中20例20眼接受玻璃体腔注射TA(1mg,0.1mL)治疗,其余20例20眼接受玻璃体腔注射雷珠单抗(0.5mg,0.05mL)治疗。观察两组治疗前及治疗后1,2wk; 1,2,3,6mo患者最佳矫正视力、黄斑中心凹厚度(CMT)及眼压的改变。

结果：TA组及雷珠单抗组于玻璃体腔注药1,2wk; 1,2,3,6mo后最佳矫正视力较治疗前明显提高(P<0.05); 但两组之间无明显差异(P>0.05)。两组于玻璃体注药后1,2wk; 1,2,3,6mo,CMT较治疗前有明显降低(P<0.05),但两组之间无明显差异(P>0.05)。TA组玻璃体腔注药后2wk及4wk眼压较治疗前明显升高(P<0.05)。雷珠单抗组玻璃体腔注药后各时间点眼压均无明显升高(P>0.05)。注药后第1,2wk; 2,3,6mo,TA组眼压改变与雷珠单抗组无明显差异(P>0.05),注药后1mo,TA组眼压改变要明显高于雷珠单抗组(P<0.05)。

结论：玻璃体腔内注射雷珠单抗是目前CRVO继发黄斑水肿的有效而且安全的治疗手段。与TA相比其在提高最佳矫正视力及降低CMT的同时几乎不会发生眼部及全身并发症。     

Treatment of central retinal vein occlusion-related macular edema with intravitreal bevacizumab (Avastin): preliminary results

PURPOSE: To assess the safety and efficacy of treatment of macular edema secondary to central retinal vein occlusion (CRVO) with intravitreal bevacizumab. PATIENTS AND METHOD: The ongoing prospective study included 8 consecutive patients (8 eyes) with macular edema secondary to CRVO (6 non ischemic and 2 ischemic), treated with intravitreal injection of 1.25 mg (0.05 mL) of bevacizumab. Main outcome was best corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by optical coherence tomography monthly during one year. Retreatment criteria include decrease of BCVA, persistence of macular edema on angiograms and increase of CFT. RESULTS: Mean age of the eight patients was 68 years (range: 50-82 years). Mean duration of symptoms before injection was 98 days (range: 3-289). Mean follow-up was 3.25 months. At baseline, mean BCVA was 0.84 logMar and mean baseline CFT was 771 microm. Mean BCVA was 0.36 and mean CFT thickness was 275 microm (n = 8) at month 1, 0.41 and 411 microm at month 2 (n = 7), 0.3 and 344 microm at month 3 (n = 6), 0.3 and 397 microm at month 4 (n = 5), respectively. In 75 % of patients, a single injection was not sufficient, and retreatment needed. No serious adverse events were observed. CONCLUSIONS: Treatment of macular edema secondary to CRVO with intravitreal bevacizumab injection of 1.25 mg was well tolerated and associated with marked macular thickness reduction and BCVA improvement in all patients. A trend towards reduction of foveal thickness and improvement of visual acuity was observed in both acute and chronic CRVO.     

Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion: one-year results

Purpose To report on the anatomic and visual acuity response after intravitreal bevacizumab injection in patients with macular edema due to non-ischemic central retinal vein occlusion (CRVO). Methods In a retrospective study, 21 consecutive patients (21 eyes) with non-ischemic CRVO underwent, on average, 3.7 intravitreal bevacizumab injections (1.25 mg). Ophthalmic examination included best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline and follow-up visits. Fluorescein angiography was performed at baseline and at follow-up visits if needed. Primary outcomes were change of BCVA and CRT. Results The follow-up period for all of the included patients was 12 months. The mean BCVA was unchanged at the 12-month examination (baseline: 20/160; 12 months: 20/160) (P = 0.771). The mean CRT decreased from 780 μm (standard deviation [SD] ± 324 μm) at the baseline to a mean of 462 μm (SD ± 248 μm) at 12 months (P < 0.05). Conclusion Intravitreal bevacizumab resulted in a significant decrease in CRT without significant improvement of visual acuity in patients with non-ischemic CRVO after a follow-up of 12 months.     

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 triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. Design: Prospective, non‐randomized, masked, interventional case series. Participants: Twenty‐four eyes of 24 subjects with centre‐involved diabetic macular oedema extending over two disc‐areas with predominant cystic changes on spectral domain optical coherence tomography were selected. Methods: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. Main Outcome Measures: Change in central macular volume on spectral domain optical coherence tomography and best‐corrected visual acuity were measured at 6‐week follow‐up. Results: Baseline data were matched in both groups. Post‐injection central macular volume (7.46 ± 0.73 mm³) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre‐injection central macular volume (9.11 ± 1.0 mm³) or when compared with the post‐injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm³). However, post‐injection best‐corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best‐corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre‐injection central macular volume (r = 0.55, P = 0.005). Conclusions: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best‐corrected visual acuity.     

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM: To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion (CRVO) treated with intravitreal injections of bevacizumab, macular grid photocoagulation combined with pan retinal photocoagulation (PRP), or both (bevacizumab+grid+PRP). METHODS: Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema. Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12mo after treatment. Excluded were patients with diabetes or any other retinal disease. We reviewed the medical records of patients treated in one ophthalmology department-comparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both. The main outcome measures were the differences in best corrected visual acuity (BCVA) and in macular thickness, as assessed by optical coherence tomography, between the enrollment and the final follow up visits. RESULTS: Sixty-five patients met inclusion criteria. There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography (131.5±41.2, 108.6±29.2, and 121.1±121.1, P=0.110), or in visual acuity (0.128±0.077, 0.088±0.057, and 0.095±0.065), for intravitreal injections, macular grid photocoagulation+PRP and a combination of the treatments, respectively, P=0.111. The proportions of patients with macular edema after treatment were: 26.1%, 28.6%, and 14.3%, respectively, P=0.499. CONCLUSION: Similar benefit was observed for intravitreal injections, laser photocoagulation, or a combined regimen in the treatment of CRVO. A non-statistically significant trend for reduction in macular edema was observed following combined treatment.     

Combined intravitreal bevacizumab and triamcinolone in exudative age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 630–634

Abstract.

Purpose: We report on the combined application of intravitreal bevacizumab and triamcinolone acetonide for treatment of exudative age‐related macular degeneration (AMD). Methods: The clinical interventional case‐series study included 16 patients (16 eyes) with exudative AMD who had previously received 3.5 ± 1.8 mono‐injections of bevacizumab (1.5 mg) without significant improvement in visual acuity (VA) or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5 mg) and triamcinolone acetonide (about 20 mg). Main outcome measures were VA and macular thickness as determined by optical coherence tomography. All patients were re‐examined at 2–3 months after the intervention. Results: Visual acuity improved significantly (p = 0.03) from 0.80 ± 0.40 logMAR prior to the combined injection to 0.65 ± 0.42 logMAR at 3 months after the injection. An improvement of ≥ 1 Snellen line was found in eight subjects, an increase of ≥ 2 lines in five subjects, and an improvement of ≥ 3 lines in two subjects. One patient lost 1 line and one patient lost 3 lines. Central retinal thickness decreased significantly from 272 ± 62 μm to 220 ± 47 μm (p = 0.03). At the 6‐month follow‐up examination, central retinal thickness had increased again to 319 ± 142 μm, which was not significantly (p = 0.30) different from baseline measurements. Conclusions: The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative AMD if previous intravitreal bevacizumab mono‐injections have failed to improve vision and reduce macular oedema.     

曲安奈德联合阿柏西普治疗雷珠单抗应答不良的湿性年龄相关性黄斑变性

目的:比较阿柏西普玻璃体内注射联合曲安奈德后部眼球筋膜下注射治疗抗血管内皮生长因子(VEGF)药物雷珠单抗应答不良的湿性年龄相关性黄斑变性(ARMD)的效果及安全性。方法:回顾性队列研究。2018-06/2020-05对抗VEGF药物雷珠单抗治疗应答不良的难治性ARMD 60例60眼,随机分为阿柏西普对照组及曲安奈德联合阿柏西普观察组,每组30例30眼。两组患者每月1次分别行单纯阿柏西普玻璃体内注射或阿柏西普玻璃内注射联合曲安奈德后部眼球筋膜下注射,连续注射3次。分别于注射前和注射第3次后1、3、6mo进行复查视力(BCVA)、黄斑中心凹厚度(CMT)及眼压的改变。结果:两组患者在治疗后1、3、6mo的BCVA及CMT均明显好转(P<0.05)。观察组治疗后1mo平均眼压较前升高,但仍在正常范围,两组眼压比较有差异(17.50±4.60 vs 18.30±3.73mmHg,P<0.05)。结论:曲安奈德后部眼球筋膜下注射联合阿柏西普玻璃体内注射治疗湿性ARMD,有效地减轻黄斑区水肿并改善视力,更加安全可靠。     

曲安奈德玻璃体腔重复注射治疗视网膜中央静脉阻塞性黄斑水肿的疗效评价

目的:研究玻璃体腔重复注射曲安奈德(intravitreal triam-cinolone,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)引起的黄斑水肿的临床效果。方法:研究对象为17例17眼接受IVTA(4mg)单次及重复注射的CRVO性黄斑水肿患者,均为人工晶状体眼或无晶状体眼(男/女=10/7),重复注射时间均为首次注射后16wk。在术前及术后1,2,3,4mo,分别测量单次注射组和重复注射组最佳矫正视力(best-corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)。采用配对-t检验对两组结果进行统计学分析。结果:单次注射组与重复注射组术前BCVA和CFT相比无显著差异。两次注射后BCVA及CFT均有短暂提高,虽然在随访结束时两组的BCVA及CFT与注射前仍有显著差异(单次注射组:P=0.032,0.049,重复注射组:P=0.01,0.008)。但重复注射组每个时间点BCVA均显著低于单次注射组(P值分别是0.043,0.011,0.010和0.012)。在注射后1,2,3mo,重复注射组CFT均显著高于单次注射组(P值分别是0.040,0.015和0.025)。单次及重复注射后眼压最高水平分别是20.0mmHg(SD2.06)和18.56mmHg(SD3.65),两者之间无显著性差异(P=0.467)。在随访期间未发现其它明显的副作用。结论:在治疗视网膜中央静脉阻塞引起的黄斑水肿时,4mgIVTA重复注射效果要差于单次注射。     

Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study

PURPOSE: To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO). METHODS: The authors conducted a retrospective study of patients with macular edema due to CRVO who were treated with at least one intravitreal injection of bevacizumab 1.25 mg in 0.05 mL. Patients underwent Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: There were 16 eyes of 15 consecutive patients with a mean age of 76.1 years (SD 9.8 years). Intravitreal triamcinolone had been previously administered to 9 patients, but all of these patients either had no improvement or had excessive intraocular pressure caused by the triamcinolone. The patients received a mean of 2.8 injections of bevacizumab per eye. No adverse events were observed, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, retinal detachment, or thromboembolic events in any patient. The mean central macular thickness at baseline was 887 microm and decreased to a mean of 372 microm at month 1 (P < 0.001). The mean baseline acuity was 20/600 (logMAR = 1.48) and the mean acuity at month 1 was 20/200 (logMAR = 1.05), a difference that was highly significant (P = 0.001). At last follow-up, a mean of 3 months after the first injection, the mean visual acuity was 20/138 (logMAR = 0.84), which was significantly better than baseline (P < 0.001). Visual acuity improvement, defined as a halving of the visual angle, was seen in 14 of the 16 eyes. CONCLUSION: Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular edema and improvement in visual acuity. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.     

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.     

Intraocular triamcinolone acetonide for macular edema due to CRVO. A multifocal-ERG and OCT study

Purpose To investigate the effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema due to central retinal vein occlusion (CRVO). A noncomparative, prospective, interventional case series. Methods In this study 15 eyes of 15 patients (9 males and 6 females) with macular edema due to non-ischemic CRVO were treated with intravitreal injection of 4 mg triamcinolone acetonide and followed-up for 1 year. Examination included measurement of best-corrected visual acuity (BCVA) for distance, measurement of intraocular pressure (IOP), fluorescein angiography, foveal retinal thickness measurement by optical coherence tomography (OCT), and multifocal electroretinography recordings (MFERG) preoperatively 3, 6 and 12 months postoperatively. Results The visual acuity increased to a significant degree at 3 months, to a smaller degree at 6 months but at 12 months there was no significant improvement. The OCT macula thickness improved to a significant level all the follow-up period but with less significance at 12 months. The MFERG recordings from the fovea showed significant improvement at 3 and 6 months. The MFERG from the parafovea area showed significant improvement at 3 and 6 and to a smaller degree at 12 months. The intraocular pressure increased at 3 and 6 months but returned to pretreatment level at 12 months. Conclusion Intravitreal injection of triamcinolone acetonide leads to a significant improvement of mean VA in patients with macular edema due to CRVO. However, this significant effect is not permanent and persists for a maximum of 3–6 months. Thereafter all the indexes tend to deteriorate.