雷珠单抗眼用注射液治疗高度近视 脉络膜新生血管的疗效分析

〔摘 要〕 目的：探究雷珠单抗眼用注射液治疗高度近视脉络膜新生血管（CNV）的治疗效果。 方法：回顾性分析 2018 年 1 月至 2019 年 12 月期间暨南大学附属广州红十字会医院收治的 29 例（33 眼）高度近视 CNV 患者临床资料,所有患者均 接受雷珠单抗眼用注射液治疗,患者均随访 1 年,比较患者治疗前后不同时间段最佳矫正视力（BCVA）、黄斑中心视网膜 厚度（CRT）。 结果： 所有患者平均注射（1.85 ± 0.46）针。治疗后 1 年随访中,治疗后 2 周患者 BCVA 较治疗前提高,治 疗后 3 个月后 BCVA 逐渐稳定;治疗后不同时间点 BCVA 均较治疗前提高,差异具有统计学意义（P ＜ 0.05）。治疗后患 者 CRT 水平较治疗前低,并持续下降至治疗后 3 个月后 CRT 水平逐渐稳定;治疗后不同时间点 CRT 水平均治疗前低,差 异具有统计学意义（P ＜ 0.05）。 结论：对高度近视 CNV 患者应用雷珠单抗眼用注射液治疗,可改善其视力水平,降低黄 斑中心视网膜厚度。     

康柏西普与雷珠单抗对RF/6A细胞增殖和迁移影响的比较

目的比较康柏西普与雷珠单抗对恒河猴脉络膜视网膜血管内皮细胞(RF/6A cells)增殖和迁移的影响。方法将RF/6A细胞分为正常组、VEGF组、康柏西普组、雷珠单抗组、康柏西普+VEGF组和雷珠单抗+VEGF组。CCK-8法检测细胞增殖;Transwell小室检测细胞迁移;流式细胞仪Annexin V-FITC/PI法检测细胞凋亡;Western blot检测蛋白AKT、p-AKT、P38MAPK及p-P38MAPK表达;实时定量PCR检测AKT mRNA和P38MAPK mRNA表达。结果 1)与正常组比,同时间不同浓度药物组细胞增殖率呈浓度依赖性降低。确定药物浓度225μg/m L和培养24 h继续实验。2)与正常组比,VEGF组细胞增殖率高,迁移数目多,单药组增殖率低,迁移数目少;与VEGF组比,VEGF+药组增殖率低,迁移数目少。3)与正常组比,VEGF组细胞凋亡率低,单药组凋亡率高;与VEGF组比,VEGF+药组凋亡率高。4)与正常组比,VEGF组磷酸化蛋白和mRNA表达高,单药组表达低;与VEGF组比,VEGF+药组表达低。结论两药通过AKT和P38MAPK信号通路抑制RF/6A细胞增殖、迁移及相关蛋白的表达。     

Acute generalised exanthematous pustulosis following intravitreal Ranibizumab

Acute generalised exanthematous pustulosis, or AGEP, is a well documented cutaneous drug reaction. It typically occurs within 48 hours of oral antibiotics, but can be caused by other medications and, occasionally, after viral infections. We present a case of AGEP following intravitreal injection of Ranibizumab, a monoclonal antibody vascular endothelial growth factor inhibitor.     

Functional and morphological changes in diabetic macular edema over the course of anti‐vascular endothelial growth factor treatment

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti‐vascular endothelial growth factor (VEGF) treatment with Ranibizumab. Methods:  A consecutive series of 39 study eyes with centre‐involving DME were included in this study. In all subjects, best‐corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD‐OCT) cross‐sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross‐sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = ?1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = ?3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = ?4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = ?1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = ?0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = ?2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti‐VEGF therapy with Ranibizumab in patients with DME.     

Significance of monitoring vascular endothelial growth factor,monocyte chemoattractant protein-1 and Interleukin-8 in diabetic macular edema towards early identification of nonresponders to ranibizumab therapy

Purpose:Identification of nonresponders prior to anti-vascular endothelial growth factor (anti-VEGF) therapy would help in the judicious clinical management of diabetic macular edema (DME) patients. Thus, a systematic study was initiated to identify nonresponding DME patient population undergoing ranibizumab treatment to figure out additional inflammatory components that may contribute to their nonresponsiveness to anti-VEGF therapy.Methods:A total of 40 patients recruited to this investigator-initiated trial received intravitreal ranibizumab monthly for 3 months. The fourth- and fifth-month injections were according to PRN protocol and the sixth-month injection was mandatory. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and VEGF in aqueous humor were measured for all the patients. Patients were grouped into responders/nonresponders on the formulated criteria and the levels of key pro-inflammatory cytokines were also measured between the two groups at baseline, 2 month and 5 months using cytometric bead array (CBA).Results:Eleven patients were categorized (29.72%) as responders and 10 patients (27.02%) as nonresponders. Nonresponders showed poorer BCVA (P = 0.024, 0.045, and 0.048 for 4, 5, and 6 months) and higher CMT (P = 0.021, 0.0008 and <0.0001 for baseline, 1, 2, 3, 4, 5, and 6 months) compared to responders. The cytokines IL-8, MCP-1 were significantly up regulated (P = 0.0048 and 0.029 for MCP-1 and IL-8) in nonresponders.Conclusion:Elevated MCP-1 and IL-8 levels found in the nonresponders could be used as a prognostic marker to identify these groups of patients and can help in developing alternative treatment options along with anti-VEGF therapy.     

A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab

Abstract

Objective:

To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.     

玻璃体腔注射Ranibizumab联合经瞳孔温热疗法治疗年龄相关性黄斑变性

目的：观察玻璃体腔注射Ranibizumab联合经瞳孔温热疗法( TTT)治疗渗出型年龄相关性黄斑变性的临床疗效及安全性。方法：选取来我院就诊并通过病史、临床症状及眼底血管照影(FFA/ICGA)和光学相干断层扫描(OCT)等辅助检查确诊的渗出型年龄相关性黄斑变性的患者160例(160眼),随机分为联合组和对照组,联合组给予单次行玻璃体腔注射Ranibizumab,7d后行TTT治疗,对照组仅行TTT治疗,随访1a,分别于治疗后1wk;1,6mo;1a,观察患者的最佳矫正视力、散瞳后眼底的变化及眼底血管照影( FFA/ICGA)及OCT的检查。
　　结果：观察期末,联合组最佳矫正视力提高34例(42.50%),对照组最佳矫正视力提高16例(20.00%),差异具有统计学意义(P<0.05)。治疗后1wk;1,6mo;1a联合组和对照组的荧光渗透有效率分别为(88.75%,62.50%);(91.25%,65.00%);(86.25%,61.25%);(78.75%,51.25%)。治疗后1 wk;1,6 mo;1 a联合组和对照组黄斑中心厚度分别为：(347.43±36.96)μm 和(423.58±29.03)μm;(287.78±34.16)μm和(387.14±32.98)μm;(301.75±37.21)μm和(415.40±31.38)μm;(326.17±27.39)μm 和(436.44±35.49)μm,两组相比,差异具有统计学意义(P<0.05)。结论：玻璃体腔注射Ranibizumab联合经瞳孔温热疗法治疗渗出型年龄相关性黄斑变性,能够使患者的视力得到改善,病灶渗漏停止或减轻,促进黄斑区出血、水肿及渗出的吸收,安全、疗效可靠,是一种有效的临床治疗方法。     

Ranibizumab Injection for Corneal Neovascularization Refractory to Bevacizumab Treatment

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.