增生性糖尿病性视网膜病变围手术期Bevacizumab(Avastin)的应用

目的 对有严重活动性的增生性糖尿病性视网膜病变患者术前眼内注射Bevacizumab（Avastin）的安全性和有效性进行评价。方法 采用前瞻性非对照研究。入选标准：增生性糖尿病视网膜病变有（1）牵引性视网膜脱离；（2）牵引性-孔源性视网膜脱离；（3）牵引性视网膜脱离合并玻璃体积血。排除标准：（1）曾患有血管栓塞性疾病（如脑梗塞）；（2）曾行玻璃体切除术。所有患眼均在行玻璃体切除术前7天接受眼内注药术，向玻璃体腔内注射2.5mg（0.1mL）Bevacizumab（Avastin）。主要观察指标是手术并发症的变化，如术中出血情况的变化、剥膜的难易程度、手术持续时间的改变等；术后早期主要观察眼内出血、纤维蛋白渗出和虹膜红变发生情况；其次是术后6个月时的最佳矫正视力及视网膜解剖复位情况。结果 30例（34眼）31~79岁患有严重活动性的增生性糖尿病性视网膜病变患者入选。术中发现所有患眼眼内新生血管膜明显萎缩，术中剥膜时出血量明显减少，手术时间相对缩短，硅油使用频率减少；术后早期并发症亦明显减少。所有患者最后一次随访时最佳矫正视力明显好于术前（P＜0.01），并且视网膜均解剖复位。结论 对于严重活动期增生性糖尿病性视网膜病变患者术前眼内注射Bevacizumab（Avastin）安全有效，可明显减少新生血管和术中出血。但该药物手术前使用的最佳时间尚待进一步研究。

Preoperative use of intravitreal Bevacizumab(Avastin)for severe active proliferative diabetic retinopathy

Objective To evaluate the safety and efficacy of Bevacizumab（Avastin） preoperative use in vitrectomy for severe active proliferative diabetic retinopathy (PDR). Methods The design of this study was an interventional consecutive, prospective study. Patients were included if they had: (1) tractional retinal detachment, (2) tractional rhegmatogenous retinal detachment, or (3) tractional detachment complicated with vitreous haemorrhage. Exclusion criteria included: (1) history of thromboembolic events (e.g. cerebral vascular events), or (2) history of vitrectomy in the study eye. An intravitreal injection of 2.5mg (0.1mL) Bevacizumab(Avastin) was preformed 7 days prior to planned vitrectomy. Main outcome measure was feasibility of surgery; secondary outcome measure was the visual and anatomic result at 6 months. Results 34 eyes of 30 patients (31-79 years old) with severe active PDR were enrolled. All cases showed remarkable regression of fibrovascular membrane with visually absent vascular component and minimum bleeding during surgical dissection of fibrovascular membrane. Less use of silicone oil was found. Post-operative best correctedvisual acuity improved from pre-operative value (P＜0.01). Anatomical attachment was achieved in all patients. Conclusion Intravitreal Bevacizumab（Avastin） administrated prior to vitrectomy is well tolerated and reduces neovascularization, and thus facilitates pars plana vitrectomy. The appropriate time of vitrectomy after Bevacizumab(Avastin) injection should be further evaluated.