玻璃体腔注射bevacizumab治疗年龄相关性黄斑变性的初步临床观察  被引量:13

A preliminary study on intravitreal injection of bevacizumab for treatment of neovascular age-related macular degeneration

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作  者:唐仕波[1] 梁小玲[1] 胡洁[1] 丁小燕[1] 万婷[1] 郭梦翔[1] 胡忆群[1] 

机构地区:[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出  处:《中华眼科杂志》2007年第10期890-896,共7页Chinese Journal of Ophthalmology

基  金:国家科学技术部“十五”攻关计划基金资助项目(2004BA702B);2006年中央保健专项资金科研课题资助项目(119)

摘  要:目的初步探讨玻璃体腔内注射bevacizumab(Avastin)治疗湿性年龄相关性黄斑变性(ARMD)的临床效果。方法采用单中心非随机对照临床研究方法。收集经荧光素眼底血管造影检查(FFA)、相干光断层成像术(OCT)确诊存在黄斑中心凹下脉络膜新生血管(CNV)的ARMD患者5例,患眼最佳矫正视力均〈0.1,无全身和局部手术禁忌证。患眼行bevacizumab玻璃体腔内注射术,用量为1.5mg(0.06ml),记录手术前、后患眼的视力、眼压、FFA和OCT的检查结果。术后随访时间4~6个月。结果全部患者均未出现眼内和全身不良反应。1例患者术后第3天出现一过性眼压升高,局部给予降眼压药物治疗后症状得到控制。1例患者术后1周视力由0.1上升至0.4;4例患者术后2个月视力提高1—6行,其中3例于术后4—6个月时视力保持稳定,1例视力下降。3例患者术后1个月黄斑水肿明显改善,黄斑中心凹视网膜厚度较术前减少5.9%~41.4%,3例患者FFA显示CNV渗漏较术前减轻。结论玻璃体腔内注射bevacizumab治疗湿性ARMD安全,副作用少,可改善患者的视功能,减轻黄斑水肿,减少CNV渗漏,有望成为药物治疗ARMD的新方法,但尚需进行多中心大样本临床随机对照研究。Objective To evaluate the short-term safety of intravitreous bevacizumab (Avastin) and its effects on visual acuity (VA) and subfoveal choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (ARMD). Methods Single-center, uncontrolled clinical study. Five ARMD patients (5 eyes) with subfoveal CNV and best-corrected VA (BCVA) less than 0.1 were participated. Patients were treated with an intraviterous injection of bevacizumab ( 1.5 mg, 0.06 ml). Ophthalmologic evaluations included BCVA test, ocular examination, intraocular pressure (IOP) measurement, optical coherence tomography (OCT) imaging and fluorescein angiography (FFA). Results There were no ocular or systemic adverse events observed, except a mild elevation of IOP [ 26 mm Hg (1 mm Hg=0. 133 kPa)] in 1 case on the 3rd day after injection, which was controlled by topical medication. One out of 5 eyes had a significant improvement of BCVA ( from 0. 1 improved to 0.4) in one week after injection. By 2 months, the BCVA increased in 4 cases ( increased 1 to 6 lines) and 3 of them remained stable for 4 to 6 months and 1 decreased at the 4 th month post injection. The thickness of central retina reduced 5.9% to 41.4% and FFA revealed a remarkable reduction or an absence of leakage from CNV in 3 eyes by the 4th month. Conclusion Our preliminary results are promising, showing that intravitreous bevacizumab therapy is well tolerated with an improvement in VA, OCT, and FFA outcomes. A multi-center randomized controlled clinical trial is needed to evaluate the long-term safety and effectiveness of intravitreous bevacizumab therapy on neovascular ARMD.

关 键 词:黄斑变性 抗体 单克隆 血管内皮生长因子A 

分 类 号:R686[医药卫生—骨科学]

 

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