玻璃体腔注射曲安奈德与贝伐单抗联合激光治疗顽固性糖尿病黄斑水肿的疗效比较

Intravitreal triamcinolone versus Bevacizumab combined with laser for the treatment of refractory diabetic macular edema

目的 观察玻璃体腔注射曲安奈德（triamcinolone acetonide,TA）或贝伐单抗（Bevacizumab）联合激光治疗顽固性糖尿病黄斑水肿（DME）的疗效.方法 临床病例对照研究.对2010年10月至2012年12月在河北医科大学第二医院眼科选择已进行全视网膜激光治疗3个月的糖尿病视网膜病变患者,经FFA及OCT检查确诊为DME患者共55例60只眼纳入观察,按就诊的先后顺序随机分两组进行玻璃体腔注射TA（ⅣTA组）和Bevacizumab（ⅣB组）,10天后黄斑补充激光治疗.比较治疗前、后两组间及各组内部的最佳矫正视力（BCVA）、眼压、黄斑中心凹厚度（CMT）及黄斑区渗漏面积的改变.结果 BCVA：两组在治疗后1、3个月均显著提高;组间比较,治疗后3个月时ⅣTA组优于ⅣB组（t=0.032,P=0.047）.CMT：治疗后1,3个月两组均显著降低,但组间比较无统计学意义（P＞0.05）;治疗后6个月与3个月相比,差异有统计学意义（P＜0.05）,治疗后6个月时ⅣTA组CMT减轻程度优于ⅣB组.FFA：两组在治疗后1、3个月FFA示黄斑区渗漏面积较治疗前均有减轻,6个月时超过50％的患者黄斑区渗漏面积再次增加,但较治疗前相比均减轻;ⅣTA组治疗后1个月时眼压较治疗前上升（t=4.58,P=0.003）,ⅣB组治疗前后眼压无统计学意义（P＞0.05）.结论 玻璃体腔注射TA或Bevacizumab治疗DME只能在短期内使黄斑水肿减轻,提高视力,不能改善视力的长期预后,需多次注射治疗。

Objective To compared the efficacy and safety of triamcinolone acetonide or anti-Vascular Endothelial Growth Factor Monoclonal Antibody Bevacizumab combined with laser treatment of DME.Methods The proliferation of pre-or proliferative phase of DR Ⅳ patients by fundus examination,FFA and OCT diagnosed as refractory diffuse DME,and central visual acuity less than 0.4 of the 60 patients included 55 cases observed.Patients were randomly divided into two groups with intravitreal injection of triamcinolone acetonide （ⅣTA） （4mg,0.1ml） or Bevacizumab （ⅣB 1.25mg,0.05ml） treatment.BCVA,intraocular pressure （IOP）,CMT,and the macular leakage area were compared between the two groups.Results After treatment,the BCVA improved significantly in both groups and macular edema reduced,but after a period of time of treatment,recurrence of edema and varying degrees,BCVA decreased again.In ⅣTA group the improvement of BC-VA could be maintained about half a year.In ⅣB group the treatment was also effective in reducing diabetic macular edema,postoperative BCVA was improved stability,and 1 month after treatment to achieve the best effect.But the efficacy only maintained a short time.The mainly complications in ⅣTA group was elevation of intraocular pressure,but there was no any complications in ⅣB group.Conclusions Bevacizumab intravitreal injection TA,or treatment of DME can only improve in the short term vision,not improve the long-term prognosis of visual acuity,require multiple injections.