血管内皮生长因子抑制剂球内注射治疗糖尿病性黄斑水肿

Evaluation of the efficacy and safety of intravitreal Avastin for diabetic macular edema

目的:评价玻璃体腔内注射1.25mg avastin治疗糖尿病性黄斑水肿(diabetic macular edema,DME)(糖尿病视网膜病变Ⅳ期和中期以上黄斑水肿)的临床效果与安全性。方法:选择我科2009-01/2010-12诊断为视力下降有临床治疗意义的糖尿病病变的患者60例(眼底荧光造影显示糖尿病视网膜病变Ⅳ期,以OCT检查显示中度以上黄斑水肿,黄斑水肿病史不超过3mo)。观察治疗前最佳矫正视力、眼压、裂隙灯及间接检眼镜检查,行彩色眼底照相、FFA,OCT检查。再观察治疗后第1,2,3d;3wk;3,6mo,视力的变化,眼压、晶状体、玻璃体、行眼底荧光造影观察视网膜渗漏情况,用TOPCON 3D-OCT检查术后视网膜的厚度进行比较。结果:玻璃体腔内注射avastin后,患者视力明显提高,视网膜中心黄斑平均厚度明显减低,由术前(395.933±119.784)μm至末次随诊为(314.200±60.528)μm,与术前相比差异有统计学意义。随访中未见眼压的异常改变,未发现白内障的加重,未发现与药物有关的视网膜毒性反应及其他局部和全身不良反应。结论:玻璃体腔内注射avastin糖尿病视网膜病变患者视力稳定提高,黄斑水肿明显消退,必要时可以连续注射治疗,但其远期治疗效果需要大样本的实验来进一步证实。

AIM：To evaluate the efficacy and safety of intravitreal avastin for diabetic macular edema（DME）（diabetic retinopathy Ⅳ period and macular edema above metaphase）·METHODS：Totally 60 patients who were diagnosed by fundus fluorescein angiography（FFA） from January 2009 to December 2010 with declining eyesight and diabetes of clinical treatment significance FFA showed diabetic retinopathy in Ⅳ period,optical coherence tomography（OCT） examination showed moderate or above macular edema,macular edema history did not exceed 3 months were selected.All eyes received a baseline eye examination before treatment,which included intraocular pressure,slit-lamp,best-corrected visual acuity,mydriatic fundus examination,and color retinal photography,FFA,OCT were performed.An intravitreal injection of avastin（1.25mg） was given at baseline and followed by two additional injections of four weeks intervals.Recording the first day,the second day,the third day,the third week,the third month,the sixth month of best-corrected visual acuity,intraocular pressure,the change of lens and vitreous,status of retinal leakage and observing postoperative central retinal thickness by OCT to compare·RESULTS：The intravitreous injection of avastin could improve vision function and decrease central macular thickness（CMT） obviously.The central macular thickness was（395.933±119.784）μm in preinjection and（314.200±60.528）μm in postinjection,showing a statistically significant difference between them.During the follow-up,no significant changes in intraocular pressure and cataract were observed.The retina toxicity reaction relevant to avastin and local or systemic adverse reactions were nothing·CONCLUSION：The intravitreous injection of avastin can relieve macular edema and improve visual acuity stably for diabetic retinopathy patients.However,its long-term treatment effect requires a large sample of experiments to further confirm.