4期早产儿视网膜病变玻璃体视网膜手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab的安全性和有效性

Safety and efficacy of preoperatively intravitreai injection of bevacizumab for stage 4 retinopathy of prematurity

目的观察4期早产儿视网膜病变（ROP）玻璃体视网膜手术前玻璃体腔注射抗血管内皮生长凶子单克隆抗体bevacizumab（商品名Avastin）的安全性和有效性。方法回顺性病例研究。临床确诊为4期ROP并接受玻璃体腔注射bevacizumab治疗的8例患儿16只眼纳入奉研究。所有患儿于表面麻醉下给予双眼玻璃体腔注射bevacizumab 0．625mg。注药后第5天，采用间接检眼镜和二代广角数码视网膜成像系统（RetCamⅡ）观察并记录患眼眼底情况，评估血管活动性；观察有无与玻璃体腔注射bevacizumab相关的不良反应。所有患儿在全身麻醉状态下行玻璃体切割手术；其中，14只眼行保留晶状体的玻璃体切割手术，2只眼行晶状体切除联合玻璃体切割手术。玻璃体切割手术后3个月，观察所有患眼视网膜复位情况以及行保留晶状体玻璃体切割手术的14只眼的品状体透明度。结果注药后第5天，所有患眼视网膜动脉纡曲及静脉扩张程度明显减轻，新生血管膜变白并有不同程度萎缩。无1例患儿发生眼内炎、眼内压增高、眼内新鲜出血、胃肠道反应等与玻璃体腔注射bevacizumab相关的不良反应。玻璃体切割手术后3个月，视网膜完全复位15只眼，占93．75％；视网膜部分复位1只眼，占6．25％。所有保留的晶状体都保持透明。结论4期ROP患儿玻璃体视网膜手术前行玻璃体腔注射bevacizumab能安伞、有效地减轻ROP血管活动性。

Objective To observe the safety and efficacy of bevacizumab pretreatment in vitrectomy for vascularly active stage 4 retinopathy of prematurity （ROP）. Methods A retrospective case series of 16 eyes of 8 patients with vascularly active stage 4 ROP who received an intravitreal injection of bevacizumab were studied. An intravitreal injection of 0. 625 mg bevacizumab was performed one week prior to planned vitrectomy. Five days after injection, the eyes were examined by indirect ophthalmoscopy and documented with fundus photography using a RetCam Ⅱ to evaluate the vascular activity. Lens sparing vitrectomy was performed in 14 eyes, while vitrectomy combined with lensectomy was performed in 2 eyes, one week after the injection. Three months after vitrectomy, the retinal status and lens clarity were observed. Results All patients showed remarkable regression of the fibrovascular membrane with clinically absent vascular component 5 days after the injection. No adverse events occurred. Three months after vitrectomy, anatomical attachment was achieved in 15 eyes （93.75%）, 1 eye （6.25%） had partial attachment. The lens remained clear in all the eyes. Conclusion Intravitreal bevacizumab administrated prior to vitrectomy reduced neovaseularization safely and effectively for stage 4 ROP .