雷珠单抗联合激光治疗视网膜分支静脉阻塞所致黄斑水肿的临床研究

目的 探讨雷珠单抗联合激光治疗视网膜分支静脉阻塞所致黄斑水肿的临床疗效和安全性.方法 将135例（144眼）RVO合并黄斑水肿患者按就诊顺序1∶1∶1随机分为3组,A组采用雷珠单抗联合激光治疗治疗,B组采用单纯激光治疗,C组采用单纯雷珠单抗注射治疗,比较各组疗效、视力变化和安全性.结果A组有效率87.50%,B、C组有效率均为64.58%,差异有统计学意义（Ridit z=16.578,P=0.000）;治疗后,3组患者视力均有提高,与治疗前相比差异有统计学意义（P〈0.05）,治疗后各组患者视力差异有统计学意义（P〈0.05）,A组视力优于B、C组.结论 雷珠单抗联合激光治疗组可以尽快消除黄斑水肿,保护中心视力.     

Long-term visual outcome of pigment epithelial tears in association with anti-VEGF therapy of pigment epithelial detachment in AMD

Purpose

Retinal pigment epithelium (RPE) tears may develop as a complication after anti-VEGF (vascular endothelial growth factor) treatment for pigment epithelial detachments (PEDs) in exudative age-related macular degeneration (AMD). This retrospective study analyses best-corrected visual acuity (BCVA) and foveal involvement after RPE tears that are associated with anti-VEGF therapy due to PED in exudative AMD.

Methods

A total of 37 patients with RPE tears during anti-VEGF therapy (bevacizumab 12, ranibizumab 21 and pegaptanib 4 eyes) for progressive PED in AMD (PED with occult choroidal neovascularization 25 eyes and PED with retinal angiomatous proliferation 12 eyes) were included in this study. We analyzed BCVA and different morphologic aspects by means of appearance on fluorescein angiography and optical coherence tomography. Mean follow-up was 88 weeks.

Results

RPE tears were diagnosed a mean of 56 days after the first injection. BCVA deteriorated after RPE tear and during follow-up significantly (P<0.001), with 53.2% of eyes being legally blind (WHO, world health organization) at 12 months. RPE-free foveal area, foveal wrinkling of the RPE, and fibrotic scar development were significantly associated with worse visual acuity.

Discussion

RPE tears can be observed in 12–15% of treated eyes during anti-VEGF therapy for PED in exudative AMD. Owing to the close time relationship with the therapy, this complication must be taken into consideration. Visual prognosis is associated with a decrease in vision in the long term, often resulting in a severe visual disability. Relevant factors for a negative visual prognosis were the potential foveal involvement of the central RPE and morphologic fibrovascular transformation of the RPE tear.     

Lucentis和Avastin治疗激光诱导恒河猴脉络膜新生血管模型的作用

目的 通过激光诱导恒河猴眼底脉络膜新生血管(choroidal neovascularization,CNV)的形成,建立和人CNV类似的动物模型,用于定量评价Lucentis和Avastin治疗激光诱导引起的CNV的效果.方法 采用眼科激光光凝仪围绕恒河猴黄斑中心凹进行光凝造模.光凝后21 d进行眼底荧光血管造影检查,根据荧光渗漏面积将动物分为空白对照组(生理盐水)、Avastin组(每眼1.25 mg)、Lucentis组(每眼0.5mg),均玻璃体内单次注射给药.给药后13 d、28 d进行眼底彩色照相、眼底荧光血管造影、光学相干断层扫描检查,给药后29 d摘取眼球进行病理学检查.结果 与空白对照组相比,Avastin组在给药后13 d和28 d,荧光渗漏面积改善率分别为56.1％和82.0％,与空白对照组相比差异均有显著统计学意义(均为P＜0.01),视网膜厚度改善率分别为14.2％和14.8％,与空白对照组相比差异均有显著统计学意义(均为P＜0.01);Lucentis组在给药后13 d和28 d,荧光渗漏面积改善率分别为66.2％和75.6％,与空白对照组相比差异均有显著统计学意义(均为P＜0.01),视网膜厚度改善率分别为19.8％和18.0％,与空白对照组相比差异均有显著统计学意义(均为P＜0.01).结论 Avastin和Lucentis对激光所致的猴眼底CNV均有明显的抑制作用.     

专业护理干预对改善雷珠单抗治疗糖尿病视网膜病变患者预后的作用

目的探讨专业护理干预对改善雷珠单抗治疗糖尿病视网膜病变患者预后的作用。方法选取2017年6月至2018年1月在该院接受雷珠单抗联合玻璃体切割术的146例糖尿病视网膜病变患者,随机分为观察组和对照组,各73例。对照组采取常规护理模式,观察组采取专业护理干预。比较患者术后3个月的视力情况、临床疗效以及采用中文版低视力者生活质量量表(CLVQOL)评价生活质量。结果两组患者术后视力比较,差异有统计学意义(P<0.05)。对照组的治疗有效率为50.68%,而观察组患者的治疗有效率为85.71%,显著高于对照组,差异有统计学意义(P<0.05)。观察组患者的CLVQOL的评分显著高于对照组,差异有统计学意义(P<0.05)。结论专业护理干预能够有效改善糖尿病视网膜病变患者在接受雷珠单抗治疗后的疗效、提高患者的生活质量,值得临床应用。     

Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab

Three anti-vascular endothelial growth factor (VEGF) therapies are currently used for the treatment of patients with wet age-related macular degeneration (AMD): pegaptanib, ranibizumab, and bevacizumab. Ranibizumab is an antibody fragment approved for the treatment of wet AMD. Bevacizumab is a full-length antibody registered for use in oncology but unlicensed for wet AMD. However, it is used off-label worldwide not only for wet AMD but also for various other ocular diseases associated with macular edema and abnormal vessel growth. We consider aspects of ranibizumab and bevacizumab in relation to their molecular characteristics, in vitro and in vivo properties, and preclinical safety data. Before 2009, most studies described the short-term toxicity of bevacizumab in multiple cell types of the eye. Since 2009, an increasing number of studies have compared the properties of ranibizumab and bevacizumab and investigated their impact on retinal cell functioning. Compared with bevacizumab, ranibizumab neutralizes VEGF better at low concentrations, maintains efficacy for longer, and has a higher retinal penetration and potency. Studies in animals demonstrate ranibizumab to be better localized to the injected eye, whereas bevacizumab appears to have a greater effect in the fellow eye. In humans, a localized and systemic effect has been reported for both molecules. In conclusion, overlapping yet distinct pharmacological properties of ranibizumab and bevacizumab indicate that safety or efficacy data from one cannot be extrapolated to the other.     

应用OCT观察Lucentis治疗视网膜静脉阻塞性黄斑水肿的疗效

目的：观察玻璃体腔注射Lucentis治疗视网膜静脉阻塞继发黄斑水肿的疗效。方法：回顾性分析玻璃体腔注射Lucentis治疗视网膜静脉阻塞性黄斑水肿患者44例（44眼）,定期随访6个月。观察治疗前及治疗后1d,2周,1、3、6个月时最佳矫正视力,OCT显示的黄斑中心凹厚度变化及并发症。结果：Lucen-tis玻璃体腔注射2周。1、3、6个月平均最佳矫正视力均提高,差异有统计学意义（P〈0．05）。随访中未见与注射及药物有关的眼部及全身不良反应。结论：Lucentis玻璃体腔注射治疗视网膜静脉阻塞引起的黄斑水肿安全有效,操作简单,必要时可重复注射治疗。     

Current choice of treatments for neovascular AMD

Age-related macular degeneration is the leading cause of irreversible blindness in developed countries with the neovascular form accounting for the majority of severe vision loss in the disease. The management of wet age-related macular degeneration has improved drastically in the past decade as anti-VEGF agents took its place at the forefront of treatment. As the choice of therapy is based on a number of factors, this review summarizes the pivotal studies that brought these agents to use and compares the different agents currently available. This review also briefly describes the promising new therapies that are in development.     

The Effects of Intravitreal Ophthalmic Medications on Intraocular Pressure

Ophthalmic medications are often given as intravitreal injection. Antimicrobials, antivirals, corticosteroids and anti- vascular endothelial growth factor agents are the main classes which can be administered through intravitreal injections. Possible complications of intravitreal injection include intraocular pressure changes, especially intraocular pressure elevations. This review discusses both injection-related intraocular pressure elevations which can occur immediately after injection of any kind of medication and drug specific-related intraocular pressure changes which may be detected days or even months after the injection.     

Macular hole after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

A 67‐year‐old man visited the clinic presenting with the complaint of decreased vision in his left eye. Visual acuity of the left eye was 6/6. On fundus examination, an orange polypoidal lesion and retinal pigment epithelial (RPE) detachment were seen. Fluorescein angiography and indocyanine green angiography were performed. There was hyperfluorescence of a clustered polyp‐like lesion. The patient was diagnosed with polypoidal choroidal vasculopathy and we recommended that he be seen again in three months. At this visit, visual acuity of the left eye had decreased to 6/9 and the RPE detachment was aggravated. Intravitreal injection of ranibizumab was performed. One month after the injection, visual acuity of his left eye was 6/96. A macular hole was seen in his left eye and vitrectomy of the left eye was performed. Optical coherence tomography was checked and it showed that the macular hole was closed. Two more intravitreal ranibizumab injections were done on the left eye. Visual acuity of his left eye subsequently improved to 6/18.8.