Department of Ophthalmology, NHIC Ilsan Hospital, Goyang, Korea.
Yonsei Med J. 2011 Jan;52(1):151-7. doi: 10.3349/ymj.2011.52.1.151.
To investigate the effect of bevacizumab (Avastin; Genentech, San Francisco, CA, USA) on vascular endothelial growth factor (VEGF) expression and inflammation in fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR).
Fibrovascular membranes from 19 eyes of 18 patients with PDR were studied using immunohistochemistry and analyzed in the following 3 groups; group 1: 4 inactive PDR eyes, group 2: 10 active PDR eyes treated preoperatively with adjunctive intravitreal bevacizumab, group 3: five active PDR eyes not treated preoperatively with bevacizumab. Immunohistochemical staining for VEGF, CD31 and CD68 were done.
The immunoreactivity to VEGF and CD 31-positive blood vessels was significantly higher in membranes from group 3 than group 1 (p = 0.007 for VEGF, 0.013 for CD 31-positive vessels). Intravitreal bevacizumab caused a reduction in VEGF expression and vascular densities in 4 out of 10 (40%) excised membranes from eyes with PDR. However, six membranes (60%) in group 2 still demonstrated relatively strong VEGF expression and high vascular density. Infiltration of macrophages was observed in 16 out of the 19 membranes, and the density of macrophages was increased in group 2 compared with group 1 (p = 0.043).
Intravitreal bevacizumab injections caused some reduction in VEGF expression and vascular densities in a limited number of active PDR patients. A single intravitreal bevacizumab injection may not be enough to induce complete blockage of VEGF and pathologic neovascularization in active PDR patients. Repeated injections, panretinal photocoagulation and/or PPV may be necessary following intravitreal bevacizumab to reinforce the anti-VEGF effect of the drug.
研究贝伐单抗（阿瓦斯汀；基因泰克，旧金山，CA，美国）对增生型糖尿病视网膜病变（PDR）患者纤维血管膜中血管内皮生长因子（VEGF）表达和炎症的影响。
使用免疫组织化学方法研究了 18 例 PDR 患者的 19 只眼中的纤维血管膜，并在以下 3 组中进行了分析；组 1：4 只非活动 PDR 眼，组 2：10 只接受贝伐单抗辅助治疗的活跃 PDR 眼，组 3：5 只未接受贝伐单抗治疗的活跃 PDR 眼。进行了 VEGF、CD31 和 CD68 的免疫组织化学染色。
组 3 纤维血管膜中 VEGF 和 CD31 阳性血管的免疫反应性明显高于组 1（VEGF 为 p = 0.007，CD31 阳性血管为 p = 0.013）。在 10 只接受 PDR 眼的玻璃体腔内贝伐单抗治疗的眼中，有 4 只（40%）切除的膜中 VEGF 表达和血管密度降低。然而，组 2 的 6 个膜（60%）仍然表现出相对较强的 VEGF 表达和高血管密度。在 19 个膜中观察到 16 个膜中有巨噬细胞浸润，并且组 2 中的巨噬细胞密度高于组 1（p = 0.043）。
玻璃体腔内贝伐单抗注射在少数活跃的 PDR 患者中引起了 VEGF 表达和血管密度的一些降低。单次玻璃体腔内贝伐单抗注射可能不足以诱导活跃的 PDR 患者中 VEGF 和病理性新生血管的完全阻断。在玻璃体腔内注射贝伐单抗后，可能需要重复注射、全视网膜光凝和/或玻璃体切除术来增强药物的抗 VEGF 作用。
