玻璃体腔内注射Bevacizumab治疗年龄相关性黄斑变性  

Intravitreal injection of Bevacizumab in treatment of AMD

作　　者：刘文杰[1] 高磊[1] 东长霞[1] 于华军[1] 姜凯[1] 林旭明[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院眼科,中国山东省烟台市264000

出　　处：《国际眼科杂志》2010年第3期540-543,共4页International Eye Science

摘　　要：目的:评估抗血管内皮生长因子单克隆抗体bevacizumab(Avastin)玻璃体腔注射治疗湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效和安全性。方法:对30例接受玻璃体腔注射bevacizumab(2.5mg)治疗的AMD患者进行回顾分析,主要评价指标包括最佳矫正视力(best-corrected visual acuity,BCVA)、黄斑中心凹厚度(central foveal thickness,CFT)和黄斑容积(total macularvolume,TMV),对注射后渗漏无明显改善或病情反复者进行眼内重复注射。所有病例都完成至少6mo的观察随访。结果:患者30例30眼中男21例,女9例,平均年龄72岁。治疗前患者的基线平均对数BCVA为1.03±0.55,CFT为364.97±151.83μm,TMV为8.36±1.84mm3,注药后1wk虽然平均CFT和TMV没有显著改善,但BCVA有显著提高(logMAR,0.79±0.33;P=0.002),经平均9.7mo的随访,BCVA(logMAR,0.70±0.40;P=0.004),CFT(272.93±81.06;P=0.005)和TMV(7.20±0.98;P=0.004)3项指标均较基线有显著改善,终末随访时BCVA提高至少两行者为18眼(60%),稳定者为8眼(27%)。本组患者共接受了58次玻璃体腔内注射,平均注射次数为1.93次/眼,有50%再注射能在术后1wk使视力提高两行或两行以上。结论:玻璃体腔注射bevacizumab能够安全有效地改善或稳定多数湿性AMD的病情,但术后定期随访以及根据病情变化进行再次注射是必要的。AIM： To evaluate the safety and efficacy of intravitreal bevacizumab（Avastin） injection in patients with exudative age-related macular degeneration （AMD）. METHODS： The records of patients treated with intravitreal injection of 2.5mg bevacizumab for AMD were retrospectively reviewed. All patients were evaluated by complete ophthalmic examination, optical coherence tomography and fluorescein and/or indocyanine green angiography. Repeated treatment with intravitreous bevacizumab occurred if there were signs of persistent or recurrent exudation. Changes in best-corrected visual acuity （BCVA）, central foveal thickness （CFT） and total macular volume （TMV） over at least 6 months were the main outcome measures. RESULTS： Thirty eyes of 30 patients （21 males and 9 females） with the average of 72 years old were included. The mean baseline of BCVA, CFT and TMV were 1.03±0. 55 （logMAR）, 364.97±151. 83μm and 8.36±1.84mm^3, respectively. Although there was no significant decrease in mean CFT and TMV one week after the injection, the mean BCVA had significant improvement （IogMAR, 0.79±0.33; P=0.02） . At the last visit of 9.7 months follow-up （ data available for 30 eyes）, BCVA （ IogMAR, 0.70±0.40 ; P=0.004）, CRT （272.93±81.06; P=0.05） and TMV （7.20±0.98; P = 0. 004） showed significant improve-ments over baseline values. BCVA was improved by at least two lines in 18 eyes （60%）, remained stable in 8 eyes （ 27% ） at the last visit. A total of 58 injections were performed and the average number of injections was 1, 93 in the group. About 50% of re-injections gained at least two lines of vision improvement one week following the re-treatment. No serious ocular or systemic adverse events were observed. CONCLUSION ： Intravitreal injection of bevacizumab for exudative AMD was well tolerated with an improvement in BCVA, CFT and TMV over the mean 9.7 months follow-up period. Re-injection of intravitreal bevacizumab should be administered if needed.

关 键 词：黄斑变性/药物疗法 脉络膜新生血管化/药物疗法 抗体 单克隆/治疗应用 BEVACIZUMAB 

分 类 号：R774.5[医药卫生—眼科]