Hoeh Alexandra E, Ach Thomas, Schaal Karen B, Scheuerle Alexander F, Dithmar Stefan
Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Graefes Arch Clin Exp Ophthalmol. 2009 Dec;247(12):1635-41. doi: 10.1007/s00417-009-1151-1. Epub 2009 Jul 26.
To evaluate the long-term outcome of an OCT-guided reinjection scheme for bevacizumab treatment of macular edema (ME) due to retinal vein occlusion.
Patients with persistent ME (>250 microm) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) received intravitreal bevacizumab 2.5 mg/0.1 ml. Visual acuity (ETDRS), ophthalmic examination and OCT were performed at baseline and at 6- to 8-week intervals. Reinjections were only performed if OCT showed persistent or recurrent ME.
Sixty-one patients with a minimum follow-up of 25 weeks were included in this analysis. Mean follow-up was 60 +/- 29 wks. In CRVO patients, central retinal thickness (CRT) decreased from 748 +/- 265 microm to 372 +/- 224 microm (p < 0.001) and visual acuity (VA) improved by 1.9 +/- 3.2 lines. In BRVO patients, mean CRT decreased from 601 +/- 206 microm to 386 +/- 178 microm (p < 0.001) and VA improved by 1.8 +/- 2.6 lines. Thirty-three percent of CRVO and 15% of BRVO patients did not show a ME recurrence for > or =25 wks at last visit. Thirty-seven percent of CRVO and 50% of BRVO patients suffered recurrences of ME within the last 25 wks, whereas 30% of CRVO and 35% of BRVO patients did not achieve a complete resolution of ME at any follow-up visit after receiving a minimum of three injections. CRVO patients with dry interval of > or =25 weeks at last visit were significantly younger, had a thinner CRT at baseline and more often had a complete resolution of ME after the first injection. In CRVO and BRVO, final VA was correlated significantly with initial VA, patients' age and final CRT. Change of VA was correlated with change of CRT in BRVO.
Patients with retinal vein occlusion benefit from treatment with bevacizumab. Favourable long-term results without necessity of further injections were achieved in 33% and 15% of CRVO and BRVO patients respectively. The remaining patients needed repeated injections to treat ME recurrences. However, one third of the CRVO/BRVO patients did not improve in VA, and further injections might be discontinued in these patients.
评估采用光学相干断层扫描（OCT）引导的再注射方案，使用贝伐单抗治疗视网膜静脉阻塞所致黄斑水肿（ME）的长期疗效。
因视网膜中央静脉阻塞（CRVO）或视网膜分支静脉阻塞（BRVO）导致持续性ME（>250微米）的患者接受玻璃体内注射2.5毫克/0.1毫升贝伐单抗。在基线以及每隔6至8周时进行视力（ETDRS）、眼科检查和OCT检查。仅当OCT显示存在持续性或复发性ME时才进行再注射。
本分析纳入了61例患者，其最短随访时间为25周。平均随访时间为60±29周。在CRVO患者中，视网膜中央厚度（CRT）从748±265微米降至372±224微米（p<0.001），视力（VA）提高了1.9±3.2行。在BRVO患者中，平均CRT从601±206微米降至386±178微米（p<0.001），VA提高了1.8±2.6行。33%的CRVO患者和15%的BRVO患者在最后一次随访时≥25周未出现ME复发。37%的CRVO患者和50%的BRVO患者在最后25周内出现ME复发，而30%的CRVO患者和35%的BRVO患者在接受至少三次注射后的任何随访中ME均未完全消退。最后一次随访时无ME间隔时间≥25周的CRVO患者明显更年轻，基线时CRT更薄，且首次注射后ME更常完全消退。在CRVO和BRVO中，最终VA与初始VA、患者年龄和最终CRT显著相关。在BRVO中，VA的变化与CRT变化相关。
视网膜静脉阻塞患者从贝伐单抗治疗中获益。分别有33%的CRVO患者和15%的BRVO患者取得了无需进一步注射的良好长期疗效。其余患者需要重复注射以治疗ME复发。然而，三分之一的CRVO/BRVO患者VA未改善，这些患者可能可停止进一步注射。
