Le Moigne O, Duncombe A, Portmann A, Muraine M, Genevois O
Service d'ophtalmologie, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
J Fr Ophtalmol. 2012 Nov;35(9):700-4. doi: 10.1016/j.jfo.2011.11.015. Epub 2012 Aug 24.
To evaluate the efficacy of bevacizumab injection used secondarily in patients with macular edema due to central retinal vein occlusion after failure of intravitreal triamcinolone acetonide injection.
The present study represents a retrospective review of eight patients presenting with central retinal vein occlusion complicated by macular edema with central foveolar thickness greater than 350 μm by Cirrus-OCT, Zeiss. Between 4 and 6 months after the central vein occlusion, all patients initially underwent intravitreal triamcinolone acetonide injection (4 mg/0.1 ml). In the case of functional or anatomic failure, three monthly bevacizumab injections (1.25mg/0.05 ml) were administered. Prior to each injection, an ophthalmic examination was performed, documenting visual acuity (ETDRS), biomicroscopy, IOP and central foveolar thickness (OCT 3).
After three intravitreal bevacizumab injections, we found no improvement in visual acuity (M0 = 45.56 ± 13 letters; M3 = 44.2 ± 8.6 letters), and no decrease in macular thickness (M0 = 559 μm ± 193; M3 = 543 μm ± 263). No intraocular pressure spikes or endophthalmitis were observed.
The lack of anatomic and functional efficacy observed in our study does not appear to be related to the method, dosage or timing of injection, nor to the presence of subretinal macroaneurysms. It may be due to a cross-resistance to these two drugs. In any event, recent approval of ranibizumab and intraocular dexamethasone implants will likely change our therapeutic approach.
In case of recalcitrant macular edema secondary to central vein occlusion after failed intravitreal triamcinolone acetonide injection, secondary intravitreal bevacizumab does not appear beneficial.
评估玻璃体内注射曲安奈德失败后，贝伐单抗注射液用于治疗视网膜中央静脉阻塞所致黄斑水肿患者的疗效。
本研究对8例经蔡司Cirrus-OCT检查显示视网膜中央静脉阻塞合并黄斑水肿、中心凹厚度大于350μm的患者进行回顾性分析。在中央静脉阻塞后4至6个月，所有患者均首先接受玻璃体内注射曲安奈德（4mg/0.1ml）。若出现功能或解剖学上的治疗失败，则每月注射3次贝伐单抗（1.25mg/0.05ml）。每次注射前均进行眼科检查，记录视力（ETDRS）、生物显微镜检查、眼压及中心凹厚度（OCT 3）。
玻璃体内注射3次贝伐单抗后，我们发现视力无改善（M0 = 45.56 ± 13字母；M3 = 44.2 ± 8.6字母），黄斑厚度也无降低（M0 = 559μm ± 193；M3 = 543μm ± 263）。未观察到眼压峰值或眼内炎。
我们的研究中观察到的解剖学和功能疗效不佳似乎与注射方法、剂量或时间无关，也与视网膜下大动脉瘤的存在无关。这可能是由于对这两种药物存在交叉耐药性。无论如何，近期雷珠单抗和眼内植入地塞米松的获批可能会改变我们的治疗方法。
对于玻璃体内注射曲安奈德失败后视网膜中央静脉阻塞所致的顽固性黄斑水肿，玻璃体内注射贝伐单抗似乎并无益处。
