Mushtaq Bushra, Crosby Niall J, Dimopoulos Antonios T, Lip Peck Lin, Stavrou Panagiota, El-Sherbiny Samer, Yang Yit
Birmingham and Midland Eye Centre, City and Sandwell National Health Service Trust, Birmingham, West Midlands, UK.
Life and Health Sciences, Aston University, Birmingham, West Midlands, UK.
Clin Ophthalmol. 2014 Apr 28;8:807-12. doi: 10.2147/OPTH.S56624. eCollection 2014.
To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting.
Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test.
In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99).
These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off.
在实际临床环境中，研究玻璃体内注射贝伐单抗治疗糖尿病性黄斑水肿（DME）且中心视网膜厚度（CRT）>400μm的眼睛与CRT<400μm的眼睛相比，是否具有更好的视力和解剖学预后。
从一家三级转诊单位的科室数据库中识别出接受玻璃体内注射贝伐单抗治疗DME的患者。首次注射后，对任何持续性黄斑水肿进行再次治疗，除非之前对重复剂量无反应。记录的参数包括视力、光学相干断层扫描（光谱域光学相干断层扫描[SD-OCT]）上的CRT以及SD-OCT特征。对基线数据和首次注射后12个月的数据进行比较，并使用学生t检验对差异进行统计学显著性检验。
总共分析了142例患者的175只眼睛。第2组（CRT>400μm）的患者注射次数明显多于第1组（CRT<400μm）（4.0次对3.3次；P=0.003）。两组在基线时存在视网膜前膜和/或玻璃体黄斑牵引的眼睛数量相似。与第1组相比，第2组CRT的降低幅度明显更大（P<0.0001）。在基线至第12个月的视力改善方面，两组平均视力均显著提高，平均提高了0.12最小分辨角对数单位（P=0.0001），但第1组和第2组之间无差异（P=0.99）。
与已发表的雷珠单抗数据相反，这些结果不支持以400μm的基线CRT作为用贝伐单抗治疗DME的截断值。我们的结果还表明，CRT较厚的患者需要更多次贝伐单抗注射，这使得这些患者的治疗成本效益较低。我们的结果可供从业者参考，以支持在不应用CRT截断值的情况下使用贝伐单抗治疗DME。
