Li Yun-Fei, Ren Qian, Sun Chao-Hui, Li Li, Lian Hai-Dong, Sun Rui-Xue, Su Xian, Yu Hua
Department of Ophthalmology, Shijiazhuang City People's Hospital, Shijiazhuang 050031, Hebei Province, China.
Department of Ophthalmology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi 832061, Xinjiang Uygur Autonomous Region, China.
World J Diabetes. 2022 Jul 15;13(7):532-542. doi: 10.4239/wjd.v13.i7.532.
Diabetes is a serious public health concern in China, with 30% of patients developing retinopathy, and diabetic macular edema (DME) having the biggest impact on vision. High blood glucose level can cause retinal cell hypoxia, thus promoting vascular endothelial growth factor (VEGF) formation and increasing vascular permeability, which induces DME. Moreover, cell hypoxia can accelerate the rate of apoptosis, which leads to the aging of patients. In severe cases, optic cell apoptosis or retinal fibrosis and permanent blindness may occur.
To investigate and compare the efficacy, mechanism, and differences between two anti-VEGF drugs (Compaq and ranibizumab) in DME patients.
Ninety-six patients with DME who attended our hospital from April 2018 to February 2020 were included and randomly divided into two groups (Compaq group and ranibizumab group). The groups received vitreal cavity injections of 0.5 mg Compaq and 0.5 mg ranibizumab, respectively, once a month. The best corrected visual acuity (BCVA), intraocular pressure (IOP), macular retinal thickness (CMT), macular choroidal thickness (SFCT), foveal no perfusion area (FAZ), superficial capillary density, deep capillary density, treatment effect, and adverse reactions were compared before and after treatment and between the two groups.
Before treatment and 1-mo post-treatment, there was no statistically significant difference in the estimated BCVA in both groups ( > 0.05). BCVA decreased in the Compaq group 3 mo after treatment, and the difference was statistically significant ( < 0.05). Before treatment, and 1 mo and 3 mo post-treatment, there was no statistically significant difference in the estimated IOP in either group ( > 0.05). Before treatment and 1-mo post-treatment, there was no statistically significant difference in the estimated CMT, SFCT, or FAZ in either group ( > 0.05). CMT and SFCT values decreased in the Compaq group 3 mo post-treatment, and the difference was statistically significant ( < 0.05). Before treatment, and 1 mo and 3 mo post-treatment, there were no statistically significant differences in vascular density in the shallow or deep capillary plexi of the fovea, parafovea, or overall macular area between the two groups ( > 0.05). Marked efficient, effective, and invalid rates were 70.83% and 52.08%, 27.08% and 39.58%, and 2.08% and 8.33% in the Compaq and ranibizumab groups, respectively. The differences between the two groups were statistically significant ( < 0.05).
Anti-VEGF drugs can effectively improve CMT and SFCT, without affecting microcirculation, thus providing an effective and safe treatment for patients with DME.
糖尿病在中国是一个严重的公共卫生问题，30%的患者会发生视网膜病变，其中糖尿病性黄斑水肿（DME）对视力影响最大。高血糖水平可导致视网膜细胞缺氧，从而促进血管内皮生长因子（VEGF）形成并增加血管通透性，进而诱发DME。此外，细胞缺氧会加速细胞凋亡速率，导致患者衰老。严重时，可能会发生视细胞凋亡或视网膜纤维化及永久性失明。
研究并比较两种抗VEGF药物（康柏西普和雷珠单抗）治疗DME患者的疗效、机制及差异。
纳入2018年4月至2020年2月在我院就诊的96例DME患者，随机分为两组（康柏西普组和雷珠单抗组）。两组分别每月1次玻璃体腔注射0.5mg康柏西普和0.5mg雷珠单抗。比较两组治疗前后及组间的最佳矫正视力（BCVA）、眼压（IOP）、黄斑视网膜厚度（CMT）、黄斑脉络膜厚度（SFCT）、中心凹无灌注区（FAZ）、浅层毛细血管密度、深层毛细血管密度、治疗效果及不良反应。
治疗前及治疗后1个月，两组预估BCVA差异无统计学意义（P>0.05）。康柏西普组治疗后3个月BCVA下降，差异有统计学意义（P<0.05）。治疗前、治疗后1个月及3个月，两组预估IOP差异均无统计学意义（P>0.05）。治疗前及治疗后1个月，两组预估CMT、SFCT或FAZ差异无统计学意义（P>0.05）。康柏西普组治疗后3个月CMT和SFCT值下降，差异有统计学意义（P<0.05）。治疗前、治疗后1个月及3个月，两组黄斑中心凹、旁中心凹或整个黄斑区浅层或深层毛细血管丛的血管密度差异均无统计学意义（P>0.05）。康柏西普组和雷珠单抗组的显著有效率、有效率和无效率分别为70.83%和52.08%、27.08%和39.58%、2.08%和8.33%。两组差异有统计学意义（P<0.05）。
抗VEGF药物可有效改善CMT和SFCT，且不影响微循环，为DME患者提供了一种有效、安全的治疗方法。
