玻璃体腔注射抗VEGF药物对糖尿病性黄斑水肿患者眼部血流动力学的影响

Effects of ocular hemodynamics after intravitreal anti-VEGF injection in patients with diabetic macular edema

目的 观察糖尿病性黄斑水肿(DME)患者经玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗后眼球后动脉血流的变化。方法 前瞻性选取2016年11月至2017年8月期间在首都医科大学附属北京友谊医院收治伴有DME的糖尿病视网膜病变患者20例(20眼)。彩色多普勒超声检查检测患者治疗前及治疗后l d、1周的眼球后血管视网膜中央动脉(CRA)、眼动脉(OA)血流动力学参数,包括收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及搏动指数(PI)。比较分析治疗前后的眼血流变化。结果 20例(20眼)DME患者平均年龄为(61.65±10.02)岁,其中男性11例(11眼),女性9例(9眼)术后第1天注射眼CRA的眼血流指标PSV、EDV、P1、R1结果分别为7.22±1.84 cm/s、1.88±0.49 cm/s、1.41±0.17、0.73±0.05,与术前进行比较,呈现明显下降( P <0.01),RI、PI差异无统计学意义( P >0.05)。术后1周注射眼的该4项眼血流指标差异均无统计学意义( P >0.05)。OA的4项眼血流指标治疗前后比较,差异无统计学意义( P >0.05)。患者对侧眼在治疗前后比较,CRA、OA的眼血流指标差异均无统计学意义( P >0.05)。结论 玻璃体腔抗VEGF注药可短暂影响DME患者注射眼的眼部血流,不影响对侧眼的眼血流动力学。

Objective To evaluate the effects in retrobulbar blood flow by using color Doppler ultrasonography in patients who had undergone a single intravitreal anti-VEGF injection for diabetic macular edema. Methods Moderate/severe non-proliferative diabetic retinopathy patients with DME were recruited. Peak systolic velocity(PSV), end-diastolic velocity (EDV), resistance index (RI), and pulsatility indices (PI) of central retinal artery (CRA) and ophthalmic artery (OA) were assessed by color Doppler ultrasonography in injected and uninjected eyes of 20 patients at baseline and at day 1 and day 7 after the injection. Results 20 patients with age 61.65±10.02 years were studied, including 11 males and 9 females. The ocular blood flow indexes PSV, EDV, P1 and R1 of CRA injected on the first day after operation were 7.22±1.84 cm/s, 1.88±0.49 cm/s, 1.41±0.17 and 0.73±0.05, respectively. Compared with those before operation, the results showed a significant decrease ( P <0.01). PSV and EDV were not significantly different in the injected eyes at day 7 after the injection ( P >0.05). In the injected eyes, there was no significant change in resistance and pulsatility indices ( P >0.05) at day 1 and day 7 after the injection. All the same parameters revealed no statistically significant difference in the uninjected eyes. Conclusion Intravitreal anti-VEGF injection for DME affects retrobulbar blood flow in injected eyes of patients with diabetic macular edema does not cause a significant difference in the retrobulbar blood flow in either the injected eye or the fellow eye.