Kook Daniel, Wolf Atmin, Kreutzer Thomas, Neubauer Aljoscha, Strauss Rupert, Ulbig Michael, Kampik Anslem, Haritoglou Christos
From the Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany.
Retina. 2008 Oct;28(8):1053-60. doi: 10.1097/IAE.0b013e318176de48.
To evaluate the long-term efficacy of bevacizumab for the treatment of chronic diffuse diabetic macular edema after various previous treatments.
A total of 126 patients (mean age: 66 years) with chronic diffuse diabetic macular edema were consecutively incorporated in this prospective, noncomparative case series. Inclusion was performed independently from the size of edema, retinal thickness, visual acuity (VA), age, metabolic control, type of diabetes, or type of previous treatments. The patients underwent a complete eye examination including best-corrected VA with ETDRS charts, slit lamp examination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, retinal thickness measurement using optical coherence tomography (OCT), fluorescein angiography, and fundus photography. All patients were treated with repeated intravitreal injections of bevacizumab (1.25 mg). Patients were observed in intervals of 4-12 weeks for a period of up to 6-12 months.
All patients had received various previous treatments such as laser treatment (62% focal laser treatment, 38% panretinal laser treatment), vitrectomy (11%), or intravitreal injection of triamcinolone (41%). All patients completed 6 months and 59 patients (47%) completed 12 months of follow-up; within this period 48% had received at least three intravitreal injections of bevacizumab. Mean diameter of foveal avascular zone was 858 +/- 341 microm. At baseline mean VA was 40.3 ETDRS letters (0.82 logMAR Snellen VA) and mean central retinal thickness on OCT was 463 microm. Throughout follow-up VA changes were not significant with a mean change of -1.6 ETDRS letters after 6 months, but significant with +5.1 ETDRS letters after 12 months. Mean central retinal thickness (OCT) decreased to 374 microm after 6 months (P < 0.001) and to 357 microm after 12 months (P < 0.001). Changes of retinal thickness and visual acuity did not correlate. No other factors investigated, such as age, central retinal thickness, or previous treatments, were predictive for a change of VA. Macular ischemia was not exacerbated as a result of the treatment.
Even in cases with chronic diffuse ischemic diabetic macular edema, a long-term decrease of central retinal thickness can be observed following repeated intravitreal injections of bevacizumab. In these patients, mean decrease in retinal thickness is aligned with a gain in mean VA. Treatment with bevacizumab at an earlier stage of diabetic macular edema without ischemia may be associated with an even better functional outcome.
评估贝伐单抗在经过各种前期治疗后对慢性弥漫性糖尿病性黄斑水肿的长期疗效。
126例慢性弥漫性糖尿病性黄斑水肿患者（平均年龄66岁）连续纳入该前瞻性、非对照病例系列研究。纳入标准与水肿大小、视网膜厚度、视力（VA）、年龄、代谢控制情况、糖尿病类型或前期治疗类型无关。患者接受了全面的眼部检查，包括使用ETDRS视力表测量最佳矫正视力、裂隙灯检查、眼压测量、黄斑部立体生物显微镜检查、使用光学相干断层扫描（OCT）测量视网膜厚度、荧光素血管造影和眼底照相。所有患者均接受重复玻璃体腔注射贝伐单抗（1.25mg）治疗。患者每隔4 - 12周接受观察，观察期长达6 - 12个月。
所有患者均接受过各种前期治疗，如激光治疗（62%为局部激光治疗，38%为全视网膜激光光凝）、玻璃体切除术（11%）或玻璃体腔注射曲安奈德（41%）。所有患者均完成了6个月的随访，59例患者（47%）完成了12个月的随访；在此期间，48%的患者接受了至少三次玻璃体腔注射贝伐单抗。黄斑无血管区平均直径为858±341μm。基线时平均视力为40.3个ETDRS字母（0.82 logMAR Snellen视力），OCT测量的平均中心视网膜厚度为463μm。在整个随访过程中，6个月时视力变化不显著，平均变化为 - 1.6个ETDRS字母，但12个月时显著提高了5.1个ETDRS字母。6个月时平均中心视网膜厚度（OCT）降至374μm（P < 0.001），12个月时降至357μm（P < 0.001）。视网膜厚度和视力的变化无相关性。所研究的其他因素，如年龄、中心视网膜厚度或前期治疗，均不能预测视力变化。治疗后黄斑缺血未加重。
即使是慢性弥漫性缺血性糖尿病性黄斑水肿患者，重复玻璃体腔注射贝伐单抗后也可观察到中心视网膜厚度长期下降。在这些患者中，视网膜厚度的平均下降与平均视力的提高一致。在糖尿病性黄斑水肿无缺血的早期阶段使用贝伐单抗治疗可能会带来更好的功能预后。
