Freitas Luiz Guilherme Azevedo de, Isaac David Leonardo Cruvinel, Tannure William Thomas, Gabriel Luís Alexandre Rassi, Reis Ricardo Gomes dos, Rassi Alan Ricardo, Freitas Clovis Arcoverde de, Ávila Marcos Pereira de
Hospital de Olhos Santa Luzia, Recife (PE), Brazil.
Arq Bras Oftalmol. 2013 May-Jun;76(3):180-4. doi: 10.1590/s0004-27492013000300010.
To evaluate the feasibility of the combined use of bevacizumab (Avastin®) and combined with infliximab (Remicade®) in the treatment of naive choroidal neovascularization due to age-related macular degeneration eyes.
Intravitreal injections of bevacizumab combined with infliximab in 6 neovascular age-related macular degeneration eyes. All patients underwent complete ophthalmologic examination on the initial visit and at days 1, 30, 60, 90, 120, 150 and 180 following the first injection. Optical coherence tomography and fluorescein angiography were performed during at initial visit and monthly during the 6 months follow-up period. Electroretinography was performed before and 30 days after initial injection, in order to evaluate retinal toxicity induced by such treatment.
Thirty days after the first injection, 5 eyes (83%) shown decrease in macular thickness. No change was seen in electroretinogram in any eyes compared to initially performed electroretinogram. All phakic eyes developed cataract. One patient developed vitritis and was submitted to medical treatment successfully. At the end of the 6 months follow-up period, 4 patients showed significant improvement in the exudative process of choroidal neovascularization. One eye had mild persistent submacular fluid without active choroidal neovascularization, and another eye had persistent amount of intraretinal fluid due to active choroidal neovascularization.
The combined use of bevacizumab with infliximab in eyes with neovascular age-related macular degeneration was effective in reducing leakage and improving the macular thickness. However, it is not possible to assert that the results were related to synergic effects of the combination therapy. A controlled study with more cases is necessary to precisely define the complication rates; however the dosage and/or association of drugs studied in this research should not be recommended in clinical practice due to cataract as well as inflammatory reaction.
评估贝伐单抗（阿瓦斯汀®）与英夫利昔单抗（类克®）联合使用治疗初发性年龄相关性黄斑变性所致脉络膜新生血管的可行性。
对6只年龄相关性黄斑变性新生血管眼进行玻璃体内注射贝伐单抗联合英夫利昔单抗。所有患者在首次就诊时以及首次注射后的第1、30、60、90、120、150和180天均接受了全面的眼科检查。在首次就诊时以及6个月随访期内每月进行光学相干断层扫描和荧光素血管造影。在首次注射前和注射后30天进行视网膜电图检查，以评估这种治疗引起的视网膜毒性。
首次注射30天后，5只眼（83%）黄斑厚度下降。与最初进行的视网膜电图相比，任何一只眼的视网膜电图均未见变化。所有有晶状体眼均发生了白内障。1例患者发生了葡萄膜炎，并成功接受了药物治疗。在6个月随访期结束时，4例患者脉络膜新生血管的渗出过程有显著改善。1只眼有轻度持续性黄斑下液，无活动性脉络膜新生血管，另1只眼因活动性脉络膜新生血管有持续性视网膜内液。
贝伐单抗与英夫利昔单抗联合用于年龄相关性黄斑变性新生血管眼可有效减少渗漏并改善黄斑厚度。然而，无法断言结果与联合治疗的协同作用有关。需要进行更多病例的对照研究以精确确定并发症发生率；然而，由于白内障以及炎症反应，本研究中所研究药物的剂量和/或联合用药不建议在临床实践中使用。
