全视网膜光凝联合玻璃体内注射贝伐单抗治疗高危增殖性糖尿病视网膜病变

Panretinal photocoagulation combined with intravitreal bevacizumab in high-risk proliferative diabetic retinopathy.

作者信息

Cho Won Bin, Oh Se Beum, Moon Jun Woong, Kim Hyung Chan

机构信息

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.

出版信息

Retina. 2009 Apr;29(4):516-22. doi: 10.1097/IAE.0b013e31819a5fc2.

DOI:10.1097/IAE.0b013e31819a5fc2

PMID:19262436

Abstract

PURPOSE

To evaluate the efficacy and safety of intravitreal bevacizumab as an adjunctive treatment to panretinal photocoagulation (PRP) for high-risk proliferative diabetic retinopathy with or without clinically significant macular edema (CSME).

METHODS

In forty-one eyes with high-risk proliferative diabetic retinopathy, intravitreal bevacizumab (1.25 mg/0.05 mL) before PRP (Plus group) or PRP alone (PRP group) was performed. Primary outcome measures were changes in best-corrected visual acuity and central macular thickness (CMT). Secondary outcome measures were the proportion of visual loss >/=0.1 logMAR, increase in CMT >/=50 mum, and eyes with development of vitreous hemorrhage.

RESULT

Best-corrected visual acuity was significantly worse at 3 months (P = 0.041) in the PRP group, whereas in the plus group, there was no significant change. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.012, 0.008) in the Plus group, whereas in the PRP group, there was no significant change. In eyes with CSME, there was no significant change in best-corrected visual acuity in both groups. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.003, 0.001) in the Plus group, whereas in the PRP group, there was no significant change. In eyes without CSME, best-corrected visual acuity was significantly worse at 1 month and 3 months (P = 0.047, 0.011) in the PRP group, whereas in the Plus group, there was no significant change. Central macular thickness was significantly worse at 1 month and 3 months (P = 0.004, 0.016) in the PRP group, whereas in the Plus group, there was no significant change. In eyes without CSME, the proportion of eyes with visual loss >/=0.1 logMAR at 1 month was significantly higher in the PRP group than in the Plus group (P = 0.020). The proportion of eyes with development of vitreous hemorrhage was significantly lower in the Plus group than in the PRP group (P = 0.023).

CONCLUSION

Intravitreal bevacizumab before PRP can be an effective adjunctive treatment to PRP in the treatment of high-risk proliferative diabetic retinopathy, especially if there is not CSME.

摘要

目的

评估玻璃体内注射贝伐单抗作为辅助治疗手段，用于伴有或不伴有临床显著性黄斑水肿（CSME）的高危增殖性糖尿病视网膜病变的全视网膜光凝（PRP）治疗的疗效和安全性。

方法

对41只患有高危增殖性糖尿病视网膜病变的眼睛，在PRP治疗前进行玻璃体内注射贝伐单抗（1.25毫克/0.05毫升）（联合治疗组）或仅进行PRP治疗（PRP组）。主要观察指标为最佳矫正视力和中心黄斑厚度（CMT）的变化。次要观察指标为视力下降≥0.1 logMAR的比例、CMT增加≥50微米的比例以及发生玻璃体出血的眼睛比例。

结果

PRP组在3个月时最佳矫正视力显著更差（P = 0.041），而联合治疗组则无显著变化。联合治疗组在1个月和3个月时中心黄斑厚度显著降低（P = 0.012，0.008），而PRP组无显著变化。在患有CSME的眼睛中，两组的最佳矫正视力均无显著变化。联合治疗组在1个月和3个月时中心黄斑厚度显著降低（P = 0.003，0.001），而PRP组无显著变化。在不伴有CSME的眼睛中，PRP组在1个月和3个月时最佳矫正视力显著更差（P = 0.047，0.011），而联合治疗组无显著变化。PRP组在1个月和3个月时中心黄斑厚度显著更差（P = 0.004，0.016），而联合治疗组无显著变化。在不伴有CSME的眼睛中，PRP组在1个月时视力下降≥0.1 logMAR的眼睛比例显著高于联合治疗组（P = 0.020）。联合治疗组发生玻璃体出血的眼睛比例显著低于PRP组（P = 0.023）。