Bevacizumab治疗视网膜静脉阻塞继发黄斑水肿的临床观察

Clinical study on Bevacizumab for macular edema induced by retinal vein occlusion

摘要:

目的：评价玻璃体腔内注射bevacizumab(贝伐珠单抗)治疗视网膜静脉阻塞(retinal vein occlusion，RVO)的临床效果与安全性。

方法：对50例56眼接受玻璃体腔注射bevacizumab(1.75mg)治疗的视网膜静脉阻塞患者进行回顾性分析，通过常规眼科检查方法、光学相干断层扫描(OCT)、眼底荧光血管造影(FFA)等方法，观察治疗后1，2，3，6mo 最佳矫正视力(best corrected visual acuity，BCVA)、眼压、晶状体、玻璃体、黄斑中心凹厚度(central foveal thickness，CFT)变化，与治疗前对比分析。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。玻璃体腔内注射bevacizumab 1.75mg，每6wk注射一次。

结果：患者50例56眼平均年龄57±18.56岁。患者48眼视力和黄斑水肿得到改善，治疗前患者的基线平均对数BCVA为logMAR0.82±0.63，CFT为626.5±178.0μm，注药后1wk虽然平均CFT没有显著改善，但BCVA有显著提高，经平均10.26±5.87mo的随访，BCVA，CFT均较基线有显著改善，CFT的统计结果显示，患者治疗后1，2，3mo黄斑中心视网膜厚度均较治疗前存在显著性差异，即黄斑中心视网膜厚度较治疗前明显变薄，黄斑水肿明显改善。RVO所致黄斑水肿(ME)患者治疗后1，3，12mo CFT分别为365.11±23.212，333.42±35.526，267.6±116.8μm，相比较有显著性差异(P<0.01)，CRVO-ME和BRVO-ME在治疗前后各时间点的CFT之间比较无统计学差异(P>0.05)。OCT图像显示治疗后黄斑视网膜厚度明显变薄。FFA显示治疗后黄斑区荧光素渗漏明显减少，即黄斑水肿明显消退。终末随访时患者BCVA提高至少两行者为48眼(86%)，稳定者为8眼(14%)。本组患者共接受了112次玻璃体腔内注射，平均注射次数为1.96次/眼，有50%再注射能在术后1wk使视力提高两行或两行以上。治疗过程中未发现严重不良反应。

结论：玻璃体腔内注射bevacizumab可改善视网膜静脉阻塞(CRVO，BRVO)继发黄斑水肿患者的视功能(VA)，减轻黄斑水肿，减少CNV渗漏，且重复治疗效果更佳。但长期治疗效果需要进一步观察。本研究中未发现与药物有关的严重的眼部及全身不良反应。

Abstract:

AIM: To evaluate the safety and efficacy of intravitreal bevacizumab injection in patients with macular edema(ME)induced by retinal vein occlusion(RVO).

METHODS: The records of patients treated with intravitreal injection of 1.75mg bevacizumab for ME induced by RVO were retrospectively reviewed. All patients were evaluated by complete ophthalmic examination, optical coherence tomography(OCT)and fundus fluorescein angiography(FFA), etc. Best corrected visual acuity(BCVA), intraocular pressure, the change of lens and vitreous, central foveal thickness(CFT)were observed at 1, 2, 3, 6mo after treatment and compared with before treatment. Repeated treatment with intravitreous bevacizumab occurred if there were signs of persistent or recurrent exudation. All the cases were followed up at least 6mo. An intravitreal injection of bevacizumab(1.75mg)was given at 6wk intervals.

RESULTS: Fifty patients(56 eyes)with the average of(57±18.56)years old were included. The mean baseline of BCVA, CFT were(logMAR0.82±0.63),(626.5±178.0)μm respectively. Although there was no significant decrease in mean CFT at 1wk after injection, the mean BCVA had significant improvement. Followed up at mean 10.26±5.87mo, BCVA, CFT showed significant improvements over baseline values. The statistics of CFT at 1, 2, 3mo after injection were significant differences compared with before injection in each of the three groups. CFT at 1, 3, 12mo after injection were(365.11±23.212)μm,(333.42±35.526)μm,(267.6±116.8)μm, which had a significant difference(P<0.001), namely macular retinal thickness was thinner obviously that before treatment, ME was improved obviously. CFT was no significant difference at each time point after injection in the group of BRVO-ME and CRVO-ME(P>0.05). OCT image showed that after injection macular retinal thickness was becoming thinner. FFA showed that after injection macular fluorescein leakage decreased. BCVA was improved by at least two lines in 48 eyes(86%),remained stable in 8 eyes(14%)at the last visit. A total of 112 injections were performed and the average number of injections was 1.96 in the group. About 50% of reinjections gained at least two lines of vision improvement at 1wk following the retreatment. There was no serious complications during the treatment.

CONCLUSION: Intravitreal injection of bevacizumab can improve visual acuity(VA)of RVO(CRVO and BRVO)in patients with ME, relieve ME, reduce the leakage of CNV, and repeated treatment is better. But a prolonged treatment effect needs further observation. There are no serious ocular and systemic complications occurred in our study.