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4 VEGF抑制剂治疗DR的安全性
理论上，玻璃体内注射贝伐单抗具有全身吸收引起的不良反应，但其应用剂量仅为静脉注射的1/400，以非结合形式到达血液循环，出现全身反应的可能性很小。贝伐单抗的安全性和有效性在动物试验、体外研究和临床中均有证实。统计表明，眼部不良反应可能有：角膜损伤、视网膜脱离、葡萄膜炎或炎症反应、晶状体损伤、眼内炎、白内障进展、视网膜动脉阻塞、视网膜下出血、急性视力下降、视网膜色素上皮脱离;全身不良反应包括急性缺血性心脏病发作、血压增高、脑血管意外或死亡，但发生率均未超过0.21%。因此，玻璃体内注射贝伐单抗并未增加药物相关性眼病和全身不良反应的比率，短期应用具有安全性。兰尼单抗最近也被FDA批准用于新生血管性AMD的治疗[1]。尽管已做了大量的研究，但是系统的随访其副作用仍然缺乏。Mason等[27]对5233例患者注射贝伐单抗后发生急性眼内炎进行了回顾性研究，结果只有1例出现急性眼内炎。Mason试验也已经提供了哌加他尼钠治疗AMD 3a的安全性数据[2830]，他们认为严重并发症与注射过程有关而与药物本身无关。来自MARINA的2a随访数据显示用兰尼单抗并没有增加全身副作用[31]。新的安全性研究还需要研究不同病种的人群，因为患糖尿病的人倾向于更年轻，伴有更多心脏和肾脏疾病，眼内状况也不一样。糖尿病患者眼内可能有更多新生血管和纤维组织，可能引起不同的副作用。为此，我们期待更多关于治疗DME远期的安全性研究。
5展望
VEGF抑制剂在治疗眼部新生血管性以及渗出性病变中疗效显著。在治疗DME以及PDR中能提高最佳矫正视力，降低后极部视网膜厚度，使需要光凝治疗者的比例明显减少。目前研究表明，玻璃体内注射VEGF抑制剂并未增加药物相关性眼病和全身不良反应的比率，短期应用是安全的。尽管VEGF抑制剂药物治疗DME的应用越来越广泛，然而目前尚无大量关于哌加他尼钠和兰尼单抗治疗PDR的试验研究，还有诸如理想的治疗剂量、用药持续时间以及可能的联合治疗方案都尚未得以解决。其长期的安全性和有效性更有待进一步研究证实。
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