Tiosano Alon, Hadad Aviel, Yanculovic Noam
Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel.
Int J Ophthalmol. 2020 Sep 18;13(9):1411-1416. doi: 10.18240/ijo.2020.09.12. eCollection 2020.
To identify risk factors for an atherothrombotic event (ATE) among patients who were treated for diabetic macular edema (DME) with intravitreal bevacizumab injections.
This retrospective study enrolled all consecutive patients with DME who were treated by intravitreal bevacizumab from 2009 through 2016 in a single center. They were divided into one group treated by bevacizumab and subsequently had an ATE and a second group also treated by bevacizumab and did not have an ATE.
A total of 455 patients with DME were enrolled. Seventy-two of the patients had an ATE. A multivariate model adjusted for age, gender, smoking, body mass index, hemoglobin A1c (HbA1c), duration of diabetes, creatinine, and blood pressure revealed an increased risk for ATE in the patients with diabetic duration of more than 13y, a systolic blood pressure over 153.5 mm Hg at first treatment, or having been treated by more than 4 intravitreal bevacizumab injections. Additionally, patients that had an ATE within 3mo from the last intravitreal treatment underwent more bevacizumab injections (5.2±3.4 3.07±1.86; <0.001).
The risk factors for an ATE identified in this study are systolic blood pressure >153.5 mm Hg, a history of diabetic mellitus for more than 13y, and treatment with more than 4 intravitreal bevacizumab injections. These factors need to be borne in mind when bevacizumab is being considered in the management of patients with DME.
确定接受玻璃体内注射贝伐单抗治疗糖尿病性黄斑水肿（DME）的患者发生动脉粥样硬化血栓形成事件（ATE）的风险因素。
这项回顾性研究纳入了2009年至2016年在单一中心接受玻璃体内贝伐单抗治疗的所有连续性DME患者。他们被分为两组，一组接受贝伐单抗治疗，随后发生了ATE，另一组同样接受贝伐单抗治疗，但未发生ATE。
共纳入455例DME患者。其中72例发生了ATE。一个针对年龄、性别、吸烟、体重指数、糖化血红蛋白（HbA1c）、糖尿病病程、肌酐和血压进行校正的多变量模型显示，糖尿病病程超过13年、首次治疗时收缩压超过153.5 mmHg或接受过4次以上玻璃体内贝伐单抗注射的患者发生ATE的风险增加。此外，如果患者在最后一次玻璃体内治疗后的3个月内发生ATE，则接受的贝伐单抗注射次数更多（5.2±3.4对3.07±1.86；P<0.001）.
本研究确定的ATE风险因素为收缩压>153.5 mmHg、糖尿病病史超过13年以及接受4次以上玻璃体内贝伐单抗注射。在考虑用贝伐单抗治疗DME患者时，需要牢记这些因素。
