孕期玻璃体腔注射抗血管内皮生长因子药物治疗研究现状

Progress of intravitreal anti-vascular endothelial growth factor during pregnancy

玻璃体腔注射抗VEGF药物在治疗眼底血管性疾病方面得到广泛应用并取得良好效果。孕早期是胎儿器官生成、血管发育的重要时期。现已有研究证明了VEGF在维持胎儿和胎盘血管系统中的重要作用,其水平缺失及下降会影响胚胎发育,导致流产。鉴于抗VEGF药物可能会对母亲和胎儿造成系统性副作用,因此关于孕期玻璃体腔注药的安全性仍存在较大争议。通过总结分析现有关于孕期使用玻璃体腔注射抗VEGF药物治疗的23例病例报道,有3例患者经贝伐单抗治疗后流产。提示临床对孕期患者使用抗VEGF药物时应谨慎,并应向患者详细说明眼部副作用和全身副作用的可能性,在决定是否在怀孕期间使用药物时,应该考虑暴露的时间与血管发育关键期的关系以及不同药物的全身暴露情况。目前临床缺乏孕期抗VEGF药物使用情况分析的大样本量研究,其安全性仍有待进一步观察分析。

Intravitreal anti-VEGF injection have been widely used in retinal vascular diseases and achieved good efficacy.Early pregnancy is an important period for fetal organ formation and vascular development.Studies have proved that VEGF plays an important role in maintaining the fetal and placental vascular system,and its loss or decline will affect embryonic development and lead to abortion.The use of intravitreal anti-VEGF during pregnancy is controversial,which may cause systemic side effects to the mother and fetus.This paper summarizes the literature of 23 cases on the use of anti-VEGF during pregnancy.Three cases reported loss of pregnancy with concomitant exposure to intravitreal bevacizumab,which suggested that we should be careful about the use of anti-VEGF during pregnancy and explain the possibility of ocular and systemic side effects to patients in detail.When deciding whether to use anti-VEGF,we should consider the relationship between exposure time and the critical period of vascular development and the systemic exposure of different drugs.Currently,there is a lack of large sample size studies on the use of anti-VEGF in pregnancy,and its safety needs to be further observed.