贝伐单抗球内注射治疗视网膜静脉阻塞黄斑水肿的疗效观察

The therapeutic effects of intravitreal injection of bevacizumab for macular edema secondary to retinal vein occlusion

目的探讨贝伐单抗球内注射治疗视网膜静脉阻塞黄斑水肿的疗效。方法前瞻性临床自身对照研究。选取2010年3月至2011年4月在大连市第三人民医院眼科就诊合并黄斑水肿的分支静脉阻塞（BRVO）患者17例17只眼、中央静脉阻塞（CRVO）患者15例15只眼，按初始视力分为最佳矫正视力1〉0．3为A组，最佳矫正视力〈0．3为B组，术前进行最佳矫正视力（BCVA），眼内压（IOP），FFA和OCT检查，玻璃体腔注射贝伐单抗1．25mg／0．05ml。分别于治疗后1天、1周、4周、12周进行随诊，记录最佳矫正视力（BCVA），眼内压（10P）和黄斑中心视网膜厚度（CMT）及并发症等情况。结果A组最佳矫正视力≥0．3组：玻璃体腔注射贝伐单抗治疗后1天、1周、4周、12周的视力与治疗前（LogMAR0．51±0．02）相比均具有统计学意义（P〈0．05），4周时达到治疗后最佳视力（Log-MAR0．15±0．09）。黄斑中心凹厚度在治疗后1周、4周、12周时与治疗前（517．8±72．4）μm相比差异均有统计学意义（P〈0．05），且在1周时黄斑水肿改善最明显。B组最佳矫正视力〈0．3组：玻璃体腔注射治疗后1天、1周、4周、12周的视力分别与治疗前相比差异均具有统计学意义（P〈0．05），1周时达到治疗后最佳视力（LogMAR0．83±0．04）。黄斑中心凹厚度在治疗后1周、4周、12周与治疗前（622．4±57．6）μm相比差异均有统计学意义（P〈0．05），且在4周时黄斑水肿改善最明显。随访中有1例中央静脉阻塞（CRVO）患者第1次注射后4周，再次出现了眼底出血视力下降，未见其他与注射及药物有关的眼部和全身不良反应。结论短期来看。IVB（intravitreal bevacizumab）玻璃体腔内注射贝伐单抗治疗RVO引起的ME是安全有效的，可以重复进行，球内注射操作简便、对组织损伤小、经济实用、患者痛苦小，是治疗视网膜静脉阻塞合并黄斑水肿的一种有效方法。

Objective To investigate the therapeutic effects of intravitreal injection of bevacizumab for macular edema secondary to retinal vein occlusion （RVO）. Methods A prospective case-observation study. Bevacizumab was injected intravitreally in 32 eyes of 32 patients with macular edema secondary to RVO determined by indirect ophthalmoscope, fundus fluorescein angiography （FFA） and optical coherence tomography （OCT）. All patients were assigned to group A or group B according to the best-corrected visual acuity （BCVA） ≥0.3 or 〈0.3 before the treatment. The best-corrected visual acuity （BCVA）, the central macular thickness （CMT） under OCT and the possible complications were recorded and analyzed prior to injection and 1 day, 1 week, 4 weeks, and 12 weeks after initial injection. The follow-up period was 12 weeks. Results The vision in group A after 1 day, 1 week, 4 weeks, and 12 weeks compared with those before treatment was statistically significant （P 〈0.05）. The central macular thickness after 1 week, 4 weeks, and 12 weeks compared withthose before treatment was statistically significant （P 〈0.05）. The vision acuity was most obviously improved in the 4 weeks and CMT was most obviously decreased in 1 week after injection. The vision in group B after 1 day, 1 week, 4 weeks, and 12 weeks compared with those before treatment was statistically significant （P 〈0.05）. The central macular thickness after 1 week, 4 weeks, and 12 weeks compared with those before treatment was statistically significant （P 〈0.05）. The vision acuity was most obviously improved in the 1 week and CMT was most obviously decreased in 4 weeks after injection. Funds bleeding occurred to a case after 4 weeks of first injection. No other ocular or systemic adverse events were found during the follow-up duration. Conclusions In the short-term, intravitreal injection of bevacizumab is safe and effective for macular edema induced by RVO with less tissue hurt by simply operation and less suffering.