Department of Ophthalmology, Hospital de Niños Roberto del Rio, Santiago, Chile.
Retina. 2010 Apr;30(4 Suppl):S32-6. doi: 10.1097/IAE.0b013e3181ca146b.
The purpose of this study was to evaluate the feasibility of performing vitrectomies after using bevacizumab (Avastin, Genentech, South San Francisco, CA) for the management of retinal detachments in retinopathy of prematurity.
Eleven eyes of 8 children with retinopathy of prematurity retinal detachment that developed despite peripheral ablation with indirect diode laser were injected with 0.625 mg bevacizumab. Injections were given through the pars plicata, and the status of the central retinal artery was checked with indirect ophthalmoscopy. A vitreoretinal surgery was scheduled for 1 week after the bevacizumab injection. All eyes underwent surgery using 25- or 23-gauge instrumentation. Demographic data, neovascular activity, and the anatomic status of the retina were evaluated. Systemic and local perioperative complications were recorded.
The average gestational birth weight was 950 g, and the average gestational age at birth was 25.7 weeks. Although 9 eyes had stage 4A, 2 had stage 4B retinal detachments. Six eyes had zone II and five eyes had zone I disease. Bevacizumab was injected at an average postgestational age of 38 weeks. A notable reduction in the vascular activity could be observed 1 week later when vitrectomy was performed. With a mean follow-up of 8.5 months (range, 2-13 months), a favorable outcome could be observed in all eyes. Only one eye with persistent vitreous hemorrhage required reoperation. No complications attributable to the bevacizumab injections were noted.
These data show that vitrectomy after intravitreal bevacizumab can be effective in selected cases. The regression of the vascular activity induced by this drug might contribute to better results in some of these cases. There were no apparent short-term safety concerns for intravitreal bevacizumab injections in these babies. However, additional studies are needed to define the role of bevacizumab as a possible adjuvant in the management of retinopathy of prematurity retinal detachments.
本研究旨在评估在早产儿视网膜病变（ROP）发生视网膜脱离后，使用贝伐单抗（Avastin，基因泰克，旧金山南部，CA）治疗的情况下进行玻璃体切除术的可行性。
对 8 名患有 ROP 视网膜脱离的儿童的 11 只眼进行间接二极管激光周边消融治疗后，注射 0.625mg 贝伐单抗。注射通过板层切开术进行，并通过间接检眼镜检查中央视网膜动脉的状态。在贝伐单抗注射后 1 周安排玻璃体视网膜手术。所有眼睛均采用 25 或 23 号器械进行手术。评估人口统计学数据、新生血管活动和视网膜解剖状态。记录全身和局部围手术期并发症。
平均胎龄出生体重为 950g，平均出生胎龄为 25.7 周。尽管 9 只眼有 4A 期，2 只眼有 4B 期视网膜脱离。6 只眼有 2 区疾病，5 只眼有 1 区疾病。贝伐单抗注射的平均胎龄为 38 周。当进行玻璃体切除术时，1 周后可以观察到血管活性明显降低。平均随访 8.5 个月（范围 2-13 个月），所有眼睛均获得良好结果。只有 1 只眼持续玻璃体积血需要再次手术。未观察到与贝伐单抗注射相关的并发症。
这些数据表明，在选择的病例中，玻璃体内注射贝伐单抗后进行玻璃体切除术可能是有效的。该药物诱导的血管活性消退可能有助于改善这些病例中的一些结果。在这些婴儿中，玻璃体内注射贝伐单抗没有明显的短期安全性问题。然而，需要进一步研究来确定贝伐单抗作为 ROP 视网膜脱离治疗辅助药物的作用。
