中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2014年
6期
693-697
,共5页
陈静%赖铭莹%罗恒%佘洁婷
陳靜%賴銘瑩%囉恆%佘潔婷
진정%뢰명형%라항%사길정
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
糖尿病性黃斑水腫%貝伐單抗%雷珠單抗%激光光凝%血管內皮生長因子
당뇨병성황반수종%패벌단항%뢰주단항%격광광응%혈관내피생장인자
Diabetic macular edema%Bevacizumab%Ranibizumab%Photocoagulation%Vascular endothelial growth factor
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.
目的 探討玻璃體腔註射兩種抗血管內皮生長因子(VEGF)藥物(貝伐單抗Bevacizumab、雷珠單抗Ranibizumab)聯閤激光光凝治療糖尿病性黃斑水腫(DME)的有效性及安全性.方法 臨床病例對照研究.選取2012年1月至2013年9月在深圳市眼科醫院就診病人,經熒光素眼底血管造影(FFA)和光學相榦斷層掃描技術(OCT)檢查確診為糖尿病性視網膜病變(DR)繼髮DME患者60例96隻眼納入觀察.其中,中度非增生期(NPDR) 15隻眼,重度NPDR 36隻眼,PDR 45隻眼.按治療方法分:單純光凝為A組、聯閤治療為B、C組,各組均為32隻眼.後兩者分彆在玻璃體腔註射貝伐單抗1.5 mg、雷珠單抗0.5 mg 1週後聯閤黃斑格柵樣光凝,對三組中的中度NPDR行次全視網膜光凝(Sub-PRP)、重度NPDR及PDR行全視網膜光凝(PRP).觀察三組治療前、後1、3、6箇月的最佳矯正視力(BCVA)、眼壓(IOP)、黃斑中心凹厚度(CMT)、視網膜新生血管(RNV)滲漏麵積和視網膜電圖(ERG)的改變,併進行比較及統計學分析.結果 聯閤治療B、C組光凝能量明顯低于A組(F=133.746,P＜0.001);其各時間點BCVA、CMT及RNV消退率均優于A組(FBCvA=142.89,FCMT=166.341,FRNV=36.749,均P＜0.001),尤其是C組;其最終ERG b波振幅高于A組(F =16.007,P＜0.001),降低幅度小于A組(F =8.034,P=0.001).聯閤治療B、C組各時間點IOP與A組比較差異無統計學意義P＞0.05 (F =0.019,P=0.890),且未髮生相關併髮癥.結論 玻璃體腔註射抗VEGF藥物能在短期內迅速有效促進RNV消退,減輕RNV滲漏以及黃斑水腫併提高視力,且雷珠單抗比貝伐單抗起效更快.聯閤療法中,抗VEGF藥物能減輕視網膜水腫,降低PRP所需能量,減輕對視網膜的損傷,減少併髮癥,從而保護視網膜的功能,且協同光凝能延遲RNV的複髮時間.
목적 탐토파리체강주사량충항혈관내피생장인자(VEGF)약물(패벌단항Bevacizumab、뢰주단항Ranibizumab)연합격광광응치료당뇨병성황반수종(DME)적유효성급안전성.방법 림상병례대조연구.선취2012년1월지2013년9월재심수시안과의원취진병인,경형광소안저혈관조영(FFA)화광학상간단층소묘기술(OCT)검사학진위당뇨병성시망막병변(DR)계발DME환자60례96지안납입관찰.기중,중도비증생기(NPDR) 15지안,중도NPDR 36지안,PDR 45지안.안치료방법분:단순광응위A조、연합치료위B、C조,각조균위32지안.후량자분별재파리체강주사패벌단항1.5 mg、뢰주단항0.5 mg 1주후연합황반격책양광응,대삼조중적중도NPDR행차전시망막광응(Sub-PRP)、중도NPDR급PDR행전시망막광응(PRP).관찰삼조치료전、후1、3、6개월적최가교정시력(BCVA)、안압(IOP)、황반중심요후도(CMT)、시망막신생혈관(RNV)삼루면적화시망막전도(ERG)적개변,병진행비교급통계학분석.결과 연합치료B、C조광응능량명현저우A조(F=133.746,P＜0.001);기각시간점BCVA、CMT급RNV소퇴솔균우우A조(FBCvA=142.89,FCMT=166.341,FRNV=36.749,균P＜0.001),우기시C조;기최종ERG b파진폭고우A조(F =16.007,P＜0.001),강저폭도소우A조(F =8.034,P=0.001).연합치료B、C조각시간점IOP여A조비교차이무통계학의의P＞0.05 (F =0.019,P=0.890),차미발생상관병발증.결론 파리체강주사항VEGF약물능재단기내신속유효촉진RNV소퇴,감경RNV삼루이급황반수종병제고시력,차뢰주단항비패벌단항기효경쾌.연합요법중,항VEGF약물능감경시망막수종,강저PRP소수능량,감경대시망막적손상,감소병발증,종이보호시망막적공능,차협동광응능연지RNV적복발시간.
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.
