贝伐单抗单用与联合曲安奈德治疗糖尿病性黄斑水肿的疗效比较

Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with bilateral diabetic macular edema

摘要:

目的：比较单用贝伐单抗与贝伐单抗联合曲安奈德治疗糖尿病黄斑水肿疗效。

方法：回顾性比较随机研究。对21例42眼黄斑水肿的糖尿病患者进行了评估。单眼内注射1.25 mg贝伐单抗(IVB 组)，在同组的眼玻璃体内注射1.25 mg贝伐单抗和1 mg曲安奈德(IVTA-IVB 组)。使用光学相干断层扫描(OCT)、ETDRS视力和眼压测量黄斑中心厚度(CMT)。

结果：平均随访时间为4.7±1.5mo。在IVB组和IVTA-IVB组中，注射前平均CMT分别为494.7±114.4 μm，546.8±165.6 μm； 第一个月分别为430.4±133.2 μm，363.7±105.3 μm； 第三个月分别为484.8±167.4 μm，407.3±108.7 μm； 六个月后分别为550.4±191.5 μm，516.8±158 μm。第一个月和第三个月存在显著差异(P<0.05)。在IVB组和IVTA-IVB组中，注射前平均ETDRS视力数分别为57.1±13.5，48.9±13.9； 第一个月分别为2.2±14，58.8±12.1； 第三个月分别为59±13.7，59.3±13.6； 第六个月分别为55.6±14.9，55.5±8.7。第三个月和第六个月存在显著差异(P<0.05)。IOP无差异。第一次注射后IVTA-IVB组在第三个月时视力最佳并持续6个月，而IVB组在第一个月时视力最佳但仅持续了3个月。

结论：6个月后发现，IVTA-IVB组较IVB组疗效显著，且无激素依赖性并发症。

Abstract:

AIM: To compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema.

METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab(IVB group)was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide(IVTA-IVB group)was performed. Main outcomes were the central macular thickness(CMT)measured with optical coherence tomography(OCT), ETDRS visual acuity(VA)and intraocular pressure(IOP).

RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 μm and 546.8±165.6 μm before injections; 430.4±133.2 μm and 363.7±105.3 μm in first month; 484.8±167.4 μm and 407.3±108.7 μm in 3^rd month; 550.4±191.5 μm and 516.8±158 μm after 6mo respectively. Differences were significant in first and 3^rd months(P<0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 in first month; 59±13.7 and 59.3±13.6 in 3^rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant in first and 3^rd and 6mo(P<0.05). There was no IOP difference. IVTA-IVB group gains best VA in 3^rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo.

CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.