Ophthalmic Surg Lasers Imaging Retina. 2020 Mar 1;51(3):145-151. doi: 10.3928/23258160-20200228-03.
To evaluate the efficacy of intravitreal ziv-aflibercept (IVZ) in patients with diabetic macular edema (DME) resistant to intravitreal bevacizumab (IVB).
This prospective study was conducted in patients with persistent DME. Patients were switched to IVZ no longer than 6 weeks after the last three consecutive monthly IVB treatments and monitored over a course of 12 weeks. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and macular volume on optical coherence tomography were compared.
A total of 59 eyes (38 patients) were included. Mean BCVA improved from 0.84 to 0.71 logMAR (P = .001) after first IVZ treatment and remained significant. In a subgroup analysis, this significance was observed only in the group with baseline visual acuity of less than 20/50. Mean CMT decreased from 479 μm to 364 μm (P = .004) after the first IVZ injections and remained significant.
IVZ may be best reserved for patients with persistent DME after initial failure with bevacizumab, with less likelihood for anatomic or functional improvement in those with mild persistent DME. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:145-151.].
评估玻璃体内注射 Ziv-阿柏西普（IVZ）治疗对玻璃体内注射贝伐单抗（IVB）抵抗的糖尿病黄斑水肿（DME）患者的疗效。
本前瞻性研究纳入了持续性 DME 患者。患者在连续三次每月 IVB 治疗结束后 6 周内转为 IVZ 治疗，并在 12 周的过程中进行监测。比较最佳矫正视力（BCVA）、中心黄斑厚度（CMT）和光学相干断层扫描黄斑容积的变化。
共纳入 59 只眼（38 例患者）。初次 IVZ 治疗后，平均 BCVA 从 0.84 提高至 0.71 对数视力（logMAR）（P =.001），且具有显著意义。在亚组分析中，仅在基线视力低于 20/50 的组中观察到这一显著意义。初次 IVZ 注射后，平均 CMT 从 479μm 降低至 364μm（P =.004），且具有显著意义。
对于初始贝伐单抗治疗失败的持续性 DME 患者，IVZ 可能是更好的选择，而对于轻度持续性 DME 患者，其解剖或功能改善的可能性较小。
