抗VEGF药物联合激光光凝治疗糖尿病性黄斑水肿观察研究  

Clinical study on anti-VEGF plus photocoagulation for diabetic macular edema

作　　者：陈静[1] 赖铭莹[1] 罗恒[1] 佘洁婷[1] 

机构地区：[1]暨南大学附属深圳市眼科医院,深圳518001

出　　处：《中国实用眼科杂志》2014年第6期693-697,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨玻璃体腔注射两种抗血管内皮生长因子（VEGF）药物（贝伐单抗Bevacizumab、雷珠单抗Ranibizumab）联合激光光凝治疗糖尿病性黄斑水肿（DME）的有效性及安全性.方法 临床病例对照研究.选取2012年1月至2013年9月在深圳市眼科医院就诊病人,经荧光素眼底血管造影（FFA）和光学相干断层扫描技术（OCT）检查确诊为糖尿病性视网膜病变（DR）继发DME患者60例96只眼纳入观察.其中,中度非增生期（NPDR） 15只眼,重度NPDR 36只眼,PDR 45只眼.按治疗方法分：单纯光凝为A组、联合治疗为B、C组,各组均为32只眼.后两者分别在玻璃体腔注射贝伐单抗1.5 mg、雷珠单抗0.5 mg 1周后联合黄斑格栅样光凝,对三组中的中度NPDR行次全视网膜光凝（Sub-PRP）、重度NPDR及PDR行全视网膜光凝（PRP）.观察三组治疗前、后1、3、6个月的最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹厚度（CMT）、视网膜新生血管（RNV）渗漏面积和视网膜电图（ERG）的改变,并进行比较及统计学分析.结果 联合治疗B、C组光凝能量明显低于A组（F=133.746,P＜0.001）;其各时间点BCVA、CMT及RNV消退率均优于A组（FBCvA=142.89,FCMT=166.341,FRNV=36.749,均P＜0.001）,尤其是C组;其最终ERG b波振幅高于A组（F =16.007,P＜0.001）,降低幅度小于A组（F =8.034,P=0.001）.联合治疗B、C组各时间点IOP与A组比较差异无统计学意义P＞0.05 （F =0.019,P=0.890）,且未发生相关并发症.结论 玻璃体腔注射抗VEGF药物能在短期内迅速有效促进RNV消退,减轻RNV渗漏以及黄斑水肿并提高视力,且雷珠单抗比贝伐单抗起效更快.联合疗法中,抗VEGF药物能减轻视网膜水肿,降低PRP所需能量,减轻对视网膜的损伤,减少并发症,从而保护视网膜的功能,且协同光凝能延迟RNV的复发时间.Objective To investigate the effects and safety of intravitreal bevacizumab （IVB） or ranibizumab （IVR） combined with photocoagulation for diabetic macular edema （DME）.Methods Ninety-six eyes of 60 patients with DME were enrolled in this study,according to fundus fluorescein angiography （FFA） and optical coherence tomography （OCT）.The patients were assigned to the simple laser photocoagulation group A and the laser combination with anti-vascular endothelial growth factor （anti-VEGF） therapy group B and C,who were treated with intravitreal 1.5mg bevacizumab or 0.5mg ranibizumab followed by photocoagulation a week later.The best corrected visual acuity （BC-VA）,intraocular pressure （IOP）,OCT,FFA and electroretinography （ERG） were examined before and 1,3,6 months after photocoagulation.Results Laser energy of the combined treatment group B and C was lower than that of group A significantly （F =133.746,P 〈0.001）.After photocoagulation,BC-VA,CMT and regression of RNV in the combined treatment group B and C were far better than that in group A （FBCVA=142.89,FCMT=166.341,FRNV=36.749,P 〈0.001）,especially group C.And the change of ERG of the combined treatment group B and C was lower than that in group A （F =8.034,P =0.001）.No significant complication occurred.Conclusions Anti-VEGF remarkably reduces the area of active leaking RNV and macular edema to improve the visual acuity in the short-term,among them,ranibizumab displayed more effective than bevacizumab.In combined treatment,Anti-VEGF significantly lessen the retinal edema leading to lower energy of photocoagulation,so that protect the function of retina and postpone the recurrence of RNV associated with photocoagulation.

关 键 词：糖尿病性黄斑水肿 贝伐单抗 雷珠单抗 激光光凝 血管内皮生长因子 

分 类 号：R587.2[医药卫生—内分泌]