Department of Ophthalmology, School of Medicine, Nihon University, Kanda, Chiyodaku, Tokyo, Japan.
Retina. 2010 May;30(5):761-4. doi: 10.1097/IAE.0b013e3181c70168.
The purpose of this study was to examine the effect of lower than usual doses of intravitreal bevacizumab (Avastin) on vitreous vascular endothelial growth factor (VEGF) concentration and intraoperative bleeding when used as preoperative adjunct therapy in patients undergoing vitrectomy for proliferative diabetic retinopathy.
Fifty-two eyes (52 patients) with indications for vitrectomy were studied; 12 received bevacizumab, and 40 did not. The bevacizumab group was given a single intravitreal injection of bevacizumab (0.16-1.25 mg) 3 days before vitrectomy. Numbers of intraoperative coagulation spots administered for hemostasis were compared between the two groups. In both groups, vitreous samples were collected during vitrectomy, and VEGF levels were measured by enzyme-linked immunosorbent assay.
The VEGF concentration was 1880.1 +/- 1927.5 in the nonbevacizumab group and 24.9 +/- 25.1 in the bevacizumab group, and the difference was significant (P = 0.0001). Although VEGF concentrations were apparently lower at higher bevacizumab doses, no significant correlation was observed (r = 0.366, P = 0.2425). Numbers of intraoperative coagulation spots differed significantly between the bevacizumab (3.2 +/- 0.8) and nonbevacizumab (5.7 +/- 1.0) groups (P < 0.0001). In the bevacizumab group, there was no correlation between the number of intraoperative coagulation spots and the bevacizumab dose (r = 0.272, P = 0.3919).
When intravitreal bevacizumab was administered as preoperative adjunct therapy to patients undergoing vitrectomy for proliferative diabetic retinopathy, the lowest dose tested (0.16 mg) was as effective as the standard dose (1.25 mg) in reducing vitreous VEGF concentrations and also decreasing intraoperative bleeding as measured by the reduced number of coagulation spots.
本研究旨在探讨在接受玻璃体切割术治疗增生性糖尿病视网膜病变的患者中，作为术前辅助治疗使用低于常规剂量的玻璃体内贝伐单抗（阿瓦斯汀）对玻璃体血管内皮生长因子（VEGF）浓度和术中出血的影响。
对 52 只眼（52 例患者）进行了研究；其中 12 只眼接受了贝伐单抗治疗，40 只眼未接受治疗。贝伐单抗组在玻璃体切割术前 3 天给予单次玻璃体内贝伐单抗（0.16-1.25mg）注射。比较两组患者术中止血所需的凝血点数。两组患者均在玻璃体切割术中采集玻璃体样本，通过酶联免疫吸附试验测定 VEGF 水平。
非贝伐单抗组 VEGF 浓度为 1880.1±1927.5pg/ml，贝伐单抗组为 24.9±25.1pg/ml，差异有统计学意义（P=0.0001）。虽然贝伐单抗剂量较高时 VEGF 浓度明显降低，但无显著相关性（r=0.366，P=0.2425）。贝伐单抗组（3.2±0.8）和非贝伐单抗组（5.7±1.0）术中凝血点数差异有统计学意义（P<0.0001）。贝伐单抗组术中凝血点数与贝伐单抗剂量之间无相关性（r=0.272，P=0.3919）。
在接受玻璃体切割术治疗增生性糖尿病视网膜病变的患者中，作为术前辅助治疗给予玻璃体内贝伐单抗时，最低测试剂量（0.16mg）与标准剂量（1.25mg）同样有效，可降低玻璃体 VEGF 浓度，并通过减少凝血点数来减少术中出血。
