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3 Avastin在眼科的临床应用进展[22,23]
3.1 脉络膜新生血管
3.1.1 渗出性年龄相关性黄斑变性伴发的CNV AMD是发达国家60岁以上人群首位致盲原因，对其伴发CNV的有效治疗有重要的经济社会学意义。Laud[24] 首次报道玻璃体腔内注射bevaeizumab治疗CNV/AMD有效，bevaeizumab对轻微典型型、隐匿型和典型为主型CNV短期应用均有效，没有明显的安全性问题。
3.1.2 其他疾病伴发的CNV 对伴发CNV的高度近视眼静脉注射[24]或玻璃体腔内注射[25] bevaeizumab 后CNV渗漏减少，平均最佳矫正视力(BCVA) 提高。视乳头旁CNV [26]及血管样条纹 [27]伴CNV患者，注药后BCVA显著提高，浆液性脱离几乎完全吸收，CNV未见明显渗漏。
3.2 虹膜和视网膜新生血管
3.2.1镰状细胞性视网膜病变 Spaide等[27]报道1例伴继发玻璃体积血(vH)和视网膜新生血管的镰状细胞视网膜病变患者，玻璃体腔内注射bevacizumab后BCVA提高，视网膜新生血管完全消退。
3.2.2早产儿视网膜病变 玻璃体腔内注射bevacizumab 0.75mg后1wk起至10wk所有虹膜新生血管及增殖的眼前节纤维血管完全消退，屈光间质透明，眼压恢复正常；随访至10mo 早产儿视网膜病变（retinopathy of prematurity, ROP)明显消退。因此作者认为bevacizumab能有效治疗ROP激光后的并发症，而且对视网膜正常血管的发育没有不良影响[28]。但该报道随访时间尚短，bevacizumab应用于ROP能否影响患者全身的正常发育目前还不能肯定，其长期的安全性和有效性仍待进一步研究[29]。
3.3 视网膜和黄斑部液体的吸收
3.3.1 AMD伴发的浆液性色素上皮脱离 AMD引起的视力下降最常见原因为CNV渗漏继发的视网膜内和视网膜下液体的积聚。玻璃体腔内注射bevacizumab后患者，浆液性色素上皮脱离（pigmen epitheliumdetachment, PED形态上改善，BCVA提高 。全身应用bevacizumab对伴有PED的CNV/AMD，尤其双侧病变、不适宜玻璃体腔内注药者也显示有很好的应用前景，患者PED平均高度及直径明显减少，BCVA明显提高。
3.3.2 糖尿病伴发的黄斑水肿 前瞻性研究[30]证实bevacizumab玻璃体腔内注射对其他方法治疗无效的弥漫性糖尿病黄斑水肿治疗效果好，治疗眼CFT降低，BCVA提高，1/3患者视力提高至少3行。此外，bevacizumab可能具有潜在抑制角膜新生血管化，使角膜恢复透明和轻度抗炎作用。
总之, VEGF 的表达与眼部新生血管形成有着密切的时空对应关系, VEGF 及其受体一直是近几十年眼部新生血管研究的中心环节。抗VEGF 治疗作为一种特异性和靶向性强的治疗手段, 无疑为眼部新生血管性疾病的治疗提供了一条新途径。未来的临床试验也将评估联合应用抗VEGF 治疗药物的可能性, 以期降低药物剂量、延长药物作用时间并减少毒副作用。
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