【摘要】 目的：观察玻璃体腔注射bevacizumab（Avastin）治疗视网膜分支静脉阻塞性黄斑水肿的有效性和安全性。方法：观察一组视网膜分支静脉阻塞引起黄斑水肿的连续病例，对其进行玻璃体腔注射bevacizumab（Avastin）后的疗效进行分析。所有患者在治疗开始前以及治疗后随诊时间点均进行完全的眼科相关检查，包括视力测定，OCT和/或FFA检查。结果：对32例患者（32眼）分别至少进行一次玻璃体腔注药（1～3次），术后平均观察时间为4.7mo。平均视力：治疗前为20/200，治疗后1mo 20/100，治疗后3mo及最近一次检查为20/100+（P＜0.01）；黄斑中心1mm区厚度：治疗前为483 μm，治疗后1,3mo及最近一次分别为 275，314和301 μm（P＜0.01）。没有观察到任何不良副作用。结论：玻璃体腔注射bvacizumab（Avastin）治疗能显著减轻视网膜分支静脉阻塞性黄斑水肿、提高视力且没有不良反应。
【关键词】 bvacizumab（Avastin）；黄斑水肿；视网膜分支静脉阻塞
Abstract
AIM:To report the safty and efficiency of intravitreal injection of bevacizumab (Avastin) in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO).
METHODS: A consecutive series of patients with ME due to BRVO who were treated with intravitreal bevacizumab injection (2.5g/0.1L) were retrospectively studied. Patients underwent complete ophthalmoscopic examination, including Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and/or flurescence angiographic testing at baseline and followup visits.
RESULTS: There were 32 eyes of 32 consecutive patients who received at least one intravitreal bevacizumab injections (range from 1 to 3). The mean length of followup was 4.7 (range from 3 to 8) months. The mean visual acuity improved from 20/200 at baseline to 20/100 at 1 month and 20/100+ at 3 months and last followup (P＜0.01）. The mean central 1mm macular thickness was 483μm at baseline and decreased to 275, 314，and 301μm at 1 month，3 months, and last followup (P＜0.01）respectively．No adverse side effects were observed following injections in any eyes.
CONCLUSION: Intravitreal bevacizumab （Avastin） showed a marked decrease in ME secondary to BRVO, improvement in visual acuity and lack of adverse side effects.
KEYWORDS: bevacizumab(Avastin); macular edema; branch retinal vein occlusion
INTRODUCTION
Macular edema (ME) associated with branch retinal vein occlusion (BRVO) is the most common complication and major cause of visual loss in BRVO. There were several available methods of treatment attempting to reduce ME in BRVO, and the first widely used one was argon laser photocoagulation. Though authors[1,2] found statistically significant differences in visual acuity improvement between eyes receiving laser treatment and control, most patients have got limited improvement in visual acuity following laser photocoagulation.
Another treatment for ME duo to BRVO was intravitreal triamcinolone acetonide (TA). Several studies[3,4] have reported improvement in visual acuity and decreased ME after intravitreal injection of TA. However, the potential benefits of this drug need to be balanced with the high risk of increased intraocular pressure[5] and the certainty of cataract formation[6], especially when repeated injections are required.
Bevacizumab (Avastin) is an agent that inhibits the effects of vascular endothelial growth factor (VEGF)[7]. Originally approved by the US Food and Drug Administration (FDA) for colon cancer therapy, bevacizumab has been used in an offlabel manner to treat ocular diseases including choroidal neovascularization (CNV) in agerelated macular degeneration (AMD). More recently, it has been offered as a treatment option for patients with retinal vein occlusion[710], and there were limited adverse side effects associated with bevacizumab injection.
Based on these reports and our own experience, bevacizumab (Avastin) was offered at Shenzhen Eye Hospital as an alternative treatment option for BRVO from March 2007 to September 2008.
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