玻璃体内注射抗血管内皮生长因子单克隆抗体bevacizumab联合超全视网膜激光光凝治疗高危型糖尿病视网膜病变  

Intravitreal injection with bevacizumab combined with extra panretinal photocoagulation for high-risk proliferative diabetic retinopathy

作　　者：王丽丽[1] 张雯[1] 李立婕[1] 金丽英[1] 霍敏[1] 何斌[1] 

机构地区：[1]西安市中心医院眼科,710003

出　　处：《中华眼底病杂志》2010年第2期116-119,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：陕西省科学技术研究发展项目（2008K0140）

摘　　要：目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）联合超全视网膜激光光凝（E-PRP）治疗高危型增生型糖尿病视网膜病变（PDR）的临床疗效.方法 对临床确诊的高危型PDR患者53例57只眼进行玻璃体腔注射bevacizumab（IVB）联合E-PRP治疗.所有患者治疗前后均常规进行视力、眼压、荧光素虹膜血管造影（IFA）以及荧光素眼底血管造影（FFA）检查、眼底照相.对比观察治疗前及治疗后视力、眼压、虹膜以及视网膜新生血管的消退情况.平均随访时间6个月.结果 IVB治疗前平均视力（0.143±0.072）,治疗后7 d平均视力（0.218±0.128）,与治疗前相比差异有统计学意义（t=-7.940,P〈0.05）.E-PRP治疗后1、3、6个月平均视力分别（0.228±0.138、0.223±0.125、0.220±0.134）,与IVB前比较,差异均有统计学意义（P〈0.05） 与IVB后比较,差异无统计学意义（P〉0.05）.57只眼中有21只眼瞳孔缘及虹膜有新生血管者.IVB治疗前平均眼压（26.632±2.629）mm Hg（1 mm Hg=0.133 kPa）,治疗后7 d平均眼压（19.316±3.092）mm Hg,与治疗前比较,差异均具有统计学意义（t=12.838,P〈0.05）.E-PRP治疗后1、3、6个月,眼压平均分别[（16.947±2.345）、（16.474±1.611）、（16.421±4.702）]mm Hg与IVB前、后比较,差异均具有统计学意义（P〈0.05）.IVB治疗后7 d,57只眼视盘及视网膜新生血管部分消退,血管渗漏明显减少或消失.其中瞳孔缘、虹膜表面新生血管者21只眼,新生血管消失,IFA检查结果显示渗漏明显减少.E-PRP治疗后2个月FFA检查结果显示,一次E-PRP有效率为68.4%,需追加激光者21.1% 其中10.5%未能控制病情行玻璃体手术.结论 IVB辅助E-PRP治疗高危PDR,可促使虹膜、视网膜新生血管迅速消退.减轻血管渗漏,阻止或预防并发症发生,高治疗效果.Objective To evaluate the therapeutic effect of intravitreal injection with bevacizumab （Avastin） （IVB）combined with extra-panretinal photocoagulation （E-PRP） for high-risk proliferative diabetic retinopathy （PDR）. Methods A total of 57 eyes of 53 patients with high-risk PDR underwent intravitreal injection combined with E-PRP. The examinations of vision acuity, intraoeular pressure, iris fluorescein angiography （IFA）, fundus photos and fundus fluorescein angiography （FFA） were performed on all of the patients before and 1, 2, 3, and 6 months after the treatment the results of the examinations before and after the treatment were compared and analyzed. The average follow up was 6 months. Results The mean visual acuity was （0. 143 ± 0. 072） before the treatment and （0. 218 ± 0. 128） 7 days after the tretment the difference was significant （t= -7. 940, P〈0.05）. The mean visual acuity 1, 3, and 6 months after E-PRP （0. 228± 0. 138, 0. 223 ± 0. 125, 0. 220 ± 0. 134, respectively） differed much from that before IVB （P〈0. 05）, but not so much from that after IVB （P〉0.05）. The mean intraoeular pressure of 21 eyes which had the neovascularization of pupil margin and iris surface before and 7 days after IVB was （26. 632±2. 629） and （19. 316±3. 092） mm Hg （1 mm Hg=0. 133 kPa）, respectively the difference was significant （t=12. 838, P〈0. 05） . The mean intraocular pressure 1, 3, and 6 months after E-PRP was （16. 947±2. 345）, （ 16.474 ± 1.611 ）, and （16. 421±4. 702 ）mm Hg, respectively, which differed much from that before and after IVB （P〈0. 05）. Neovascularization on the disc and the retinae of 57 eyes were subsided partly, and a significant reduction or disappeared of the area of retinal neovascularization and the blood vessel leakage were observed 7 days after IVB. The neovascularization of pupil margin and iris surface of 21 eyes disappeared, and the IFA leakage decreased. The results of FFA 2 months after E-PRP showed

关 键 词：糖尿病视网膜病变/治疗 激光凝固术/方法 抗体 单克隆/药物作用 

分 类 号：R774.1[医药卫生—眼科] R587.26[医药卫生—临床医学]