玻璃体腔内注射贝伐单抗后视网膜电图明视负向反应改变

Changes of photopic negative response in patients with exudative age-related macular degeneration and proliferative diabetic retinopathy after intravitreal injections of bevacizumab

目的研究玻璃体腔内注射贝伐单抗后渗出性年龄相关性黄斑变性(AMD)、增生性糖尿视网膜病变(PDR)患者视力、闪光视网膜电图(ERG)明视负向反应(PhNR)和黄斑神经上皮层厚度(CRT)变化。设计回顾性、自身对照研究。研究对象8例渗出性AMD患者(9眼)和3例PDR患者(3眼)。方法患者于表面麻醉下给予1.25 mg(0.05m1)贝伐单抗玻璃体腔内注射。患者治疗前及治疗后1个月检查EDTR视力、眼压、视野、荧光素眼底血管造影、相干光断层扫描和闪光ERG。主要指标PhNR振幅、视力和CRT。结果治疗前后CRT显著下降(n=12,P=0.008),但PhNR振幅和视力变化不显著(n=12,P=0.153)。CRT与PHNR振幅(r=0.294,P=0.145)、CRT与视力无显著相关性(r=-0.358,P=0.073)。结论玻璃体腔内单次注射贝伐单抗可减轻渗出性AMD和PDR患者的黄斑水肿,但对视功能的改善需要进一步的观察。

Objective To evaluate the changes of the waveform of the photopic negative response in flash-electroretinogram, visual acuity and central retinal thickness in the treatment of intravitreal injections of bevacizumab. Design Retrospective self-comparative case series. Participants 8 subjects （9 eyes） with exudative age-related macular degeneration and 3 subjects （3eyes） with proliferative diabetic retinopathy. Method Evaluation protocol included examinations of the Early Treatment Diabetic Retinopathy study visual acuity, visual field, intraocular pressure, fundus fluorescein angiography, optical coherence tomography and flash-electroretinogram. Intravitreal injections of bevacizumab, 1.25 mg （0.05ml）, were given under an operating microscope and aseptic conditions. All the subjects were followed-up one month later. Main outcome Measure The amplitudes of PhNR, visual acuity and central retinal thickness. Result At 1 months, the mean amplitudes of PhNR and mean visual acuity in all cases had no obvious change （n=12, P〉0.05）.The central retinal thickness reduced obviously （n= 12, P〈0.05 ）, but it was neither significantly correlated with PhNR （r=0.294, P=0.145） nor with visual acuity（r =-0.358, P=0.073 ）. Conclusion The single intravitreal injection of bevaeizumab is showed promising in absorption of intraretinal edema and subretinal fluid in patients with exudative age-related macular degeneration and proliferative diabetic retinopathy, but the changes of visual function （including PhNR） might need further investigation. （Ophthalmol CHN, 2009, 18： 243-246）