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 injection of triamcinolone acetonide versus bevacizumab for diabetic macular edema

Objective To compare the clinical efficacy of intravitreal triamcinolone acetonide (TA)and intravitreal bevacizumab for diabetic macular edema (DME). Methods In a total of 68 cases (82 eyes)with DME who underwent routine ocular examination and optic coherence tomography were enrolled in this study. The patients were divided into two groups for intravitreal TA (4mg, 0.1ml) or intravitreal bevacizumab (1.25mg, 0.05ml) injection. The difference of age, diabetes duration, macular edema duration, best corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure between TA group (37 cases, 45eyes) and bevacizumab group (31 cases, 37 eyes) were insignificant. The change ofBCVA, CMT and intraocular pressure at 4-week, 8-week and 12-week follow-up between the two groups were compared. Results At the 4-week, 8-week and 12-week follow-up, the change of BCVA between TA group and bevacizumab group did not vary significantly (t =-0.316, 0.896, and 0.879; P =0.754, 0.389 and 0.384, respectively). At 4-week and 12-week follow-up, the reduction of macular edema in TA group was significantly higher than bevacizumab group (t =-1.892 and -3.007; P =0.036 and 0.004, respectively). At the 8-week follow-up, the reduction of macular edema between two groups were insignificant (t =-0.362; P =0.722). At the 8-week and 12-week follow-ups, intraocular pressure in TA group were significantly higher than bevacizumab group (t =2.334 and 2.600; P =0.026 and 0.015, respectively). Conclusions Intravitreal injection of triamcinolone acetonide is more effective than intravitreal injection of bevacizumab in reducing the thickness of macular edema. Moreover, the efficacy ofintravitreal TA last for a longer time than bevacizumab. Randomized, control and multicenter study with large scale patients is needed.