Ashraf M, Souka A A, Daich Varela M, El Kayal H, Schlottmann P G
Departamento de Oftalmología, Facultad de Medicina, Universidad de Alejandría, Alejandría, Egipto.
Hospital Oftalmológico Santa Lucía, Buenos Aires, Argentina.
Arch Soc Esp Oftalmol (Engl Ed). 2018 Nov;93(11):523-529. doi: 10.1016/j.oftal.2018.04.001. Epub 2018 May 31.
To determine the efficacy of switching to ranibizumab in patients with diabetic macular oedema refractory to treatment with bevacizumab, and to evaluate the outcomes when switching back to bevacizumab.
A prospective study was conducted that included 43 eyes of 31 patients refractory to previous bevacizumab treatment. The patients were switched to ranibizumab, and optical coherence tomography was performed one month post-injection. Patients showing improvement (>10% reduction in central sub-field thickness) were switched back to bevacizumab, and optical coherence tomography was performed one month post-switch back.
The 34 eyes switched to ranibizumab showed a statistically significant improvement in mean best corrected visual acuity from 0.67±0.39 logMAR to a mean of 0.55±0.36 logMAR (P<.05). In addition, there was a statistically significant decrease in central subfield thickness (CST) from a mean of 475.3±122.8 to a mean of 417.3±109.1 (P<.05). In the 21 eyes that were switched back to bevacizumab, there was no significant difference either in the change in CST or in the change in best corrected visual acuity post-switch back.
Switching to ranibizumab in patients improves both the best corrected visual acuity and CST in diabetic patients refractory to previous bevacizumab treatment. This effect is pronounced in patients with increased CST prior to the switch. Switching back to bevacizumab adds no further improvement.
确定在对贝伐单抗治疗无效的糖尿病性黄斑水肿患者中改用雷珠单抗的疗效，并评估换回贝伐单抗后的结果。
进行了一项前瞻性研究，纳入了31例先前接受贝伐单抗治疗无效的患者的43只眼。患者改用雷珠单抗，并在注射后1个月进行光学相干断层扫描。显示改善（中心子野厚度减少>10%）的患者换回贝伐单抗，并在换回后1个月进行光学相干断层扫描。
改用雷珠单抗的34只眼平均最佳矫正视力从0.67±0.39 logMAR有统计学意义地提高到平均0.55±0.36 logMAR（P<0.05）。此外，中心子野厚度（CST）从平均475.3±122.8有统计学意义地降低到平均417.3±109.1（P<0.05）。在换回贝伐单抗的21只眼中，换回后CST的变化或最佳矫正视力的变化均无显著差异。
对于先前贝伐单抗治疗无效的糖尿病患者，改用雷珠单抗可改善最佳矫正视力和CST。这种效果在改用前CST增加的患者中尤为明显。换回贝伐单抗没有进一步改善。
