Arevalo J Fernando, Sanchez Juan G, Lasave Andres F, Wu Lihteh, Maia Mauricio, Bonafonte Sergio, Brito Miguel, Alezzandrini Arturo A, Restrepo Natalia, Berrocal Maria H, Saravia Mario, Farah Michel Eid, Fromow-Guerra Jans, Morales-Canton Virgilio
Retina and Vitreous Service, Caracas Clinical Opthalmology Center, Caracas 1010, Venezuela.
J Ophthalmol. 2011;2011:584238. doi: 10.1155/2011/584238. Epub 2011 Mar 30.
This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.
本文证明了玻璃体内注射贝伐单抗（IVB）对糖尿病视网膜病变（DR）的多种益处，包括在24个月随访期内对糖尿病性黄斑水肿（DME）和增殖性糖尿病视网膜病变（PDR）的益处。这是一项回顾性多中心介入性对比病例系列研究，纳入了接受玻璃体内注射1.25或2.5mg贝伐单抗治疗DME、无牵拉性视网膜脱离（TRD）的PDR，以及在玻璃体切割术治疗PDR前接受玻璃体内注射1.25或2.5mg贝伐单抗后发生或病情进展的TRD患者。结果表明，IVB注射可能对弥漫性DME的黄斑厚度和视力（VA）有有益影响。因此，在未来这种新疗法可以补充DME的局部/格栅激光光凝治疗。在PDR中，这种新选择可以作为全视网膜光凝的辅助药物，从而可以应用更具选择性的治疗方法。最后，PDR中的TRD可能在IVB作为玻璃体切割术的辅助治疗后发生或进展。应在IVB后4天进行手术。大多数患者糖尿病控制不佳，伴有糖化血红蛋白升高、使用胰岛素、对全视网膜光凝难治的PDR，以及IVB与玻璃体切割术之间的时间间隔较长。
