玻璃体腔注射抗VEGF药物治疗糖尿病性视网膜病变视网膜新生血管的疗效

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摘要目的：探讨玻璃体腔注射抗血管内皮生长因子（VEGF）药物治疗糖尿病性视网膜病变（DR）视网膜新生血管的疗效。方法：回顾性分析2016年1月1日至2018年4月28日于温州医科大学附属眼视光医院行眼底荧光血管造影（FFA）的DR患者。首次和末次抗VEGF治疗的间隔为抗VEGF治疗总时长（若只有1次治疗，则记为0）。末次抗VEGF治疗与治疗后FFA之间的间隔定义为治疗空窗期。结果：共纳入患者20例，24眼，其中男10例，女10例，年龄（53.9±12.8）岁。抗VEGF治疗平均次数为2.5（1，3）次，抗VEGF治疗总时长为62.0（0，76.8）d。治疗空窗期为48.5（30.0，64.8）d。15眼（占62.5%）单纯抗VEGF治疗后视网膜新生血管完全消退，其余9眼（占37.5%）部分消退且未见新的新生血管生成。治疗空窗期的延长是治疗后仍有新生血管的危险因素（OR=1.089，95%CI=1.018～1.166，P=0.014）。4眼延长治疗空窗期为177.0（90.5，234.3）d，均可见消退的新生血管重新出现。结论：玻璃体腔注射抗VEGF药物治疗DR视网膜新生血管有效，但可能复发，需重复治疗。

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关键词 ：抗VEGF, 糖尿病视网膜病变, 视网膜新生血管, 眼底荧光血管造影

Abstract：Objective: To investigate the efficacy of anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection for retinal neovascularization in diabetic retinopathy (DR) patients. Methods: In this retrospective study, DR patients who took fundus fluorescein angiography (FFA) examination from January 1, 2016 to April 28, 2018 at the Affiliated Eye Hospital of Wenzhou Medical University were reviewed. Inclusion criteria were as follows: ①patients with retinal neovascularization based on baseline FFA; ②Patients who only accepted anti-VEGF treatment, at least once; ③Patients who took FFA examinations again after all anti-VEGF treatments within 3 months. For the sake of analysis, the interval between the first and last anti-VEGF treatment was recorded as the duration of anti-VEGF treatment (it was zero when only one anti-VEGF treatment was given). And ‘untreatment period’ was the time between the last anti-VEGF treatment and the following FFA. Results: 20 patients (10 males and 10 females), 24 eyes were studied, with the average age being (53.9±12.8) years old. The mean number of anti-VEGF treatments was 2.5(1, 3), and the median total duration of anti-VEGF treatments was 62.0 (0, 76.8) days. The median untreatment period was 48.5 (30.0, 64.8) days. Through FFA, 15 eyes (62.5%) recovered from retinal neovascularization completely after anti-VEGF treatment, whereas the other 9 eyes (37.5%) recovered from retinal neovascularization partly and without new retinal neovascularization. The prolongation of untreatment period was a risk factor for neovascularization (OR=1.089, 95%CI=1.018-1.166, P=0.014). Four eyes had the median prolonged un-treatment period of 177.0 (90.5, 234.3) days, and recurrence of neovascularization was observed. Conclusion: Intravitreal injection of anti-VEGF is effective in control of retinal neovascularization of DR. Retinal neovascularization may recur, and thus repeated treatment is required.

Key words： Anti-VEGF diabetic retinopathy retinal neovascularization fundus fluorescein angiography

收稿日期: 2018-06-22

通讯作者: 林冰，副主任医师，Email：438398272@qq.com。

作者简介: 黄颖（1985-），女，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I7/482

[1] 张承芬. 眼底病学[M]. 2版. 北京: 人民卫生出版社, 2010: 260.
[2] ZHANG X, SAADDINE J B, CHOU C F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008[J]. JAMA, 2010, 304(6): 649-656.
[3] American Academy of Ophthalmology Retina/Vitreous Panel. Diabetic Retinopathy PPP-Updated 2017[EB/OL]. [2018-06-22]. https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp-updated-2017.
[4] WITMER A N, VRENSEN G F, VAN NOORDEN C J, et al. Vascular endothelial growth factors and angiogenesis in eye disease[J]. Prog Retin Eye Res, 2003, 22(1): 1-29.
[5] Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings, DRS report number 8[J]. Ophthalmology, 1981, 88(7): 583-600.
[6] The Diabetic Retinopathy Study Research Group. Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report No. 14[J]. Int Ophthalmol Clin, 1987, 27(4): 239-253.
[7] Early Treatment Diabetic Retinopathy Study Research Group. Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study report number 3[J]. Int Ophthalmol Clin, 1987, 27(4): 254-264.
[8] Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 2[J]. Ophthalmology, 1987, 94(7): 761-774.
[9] Early Treatment Diabetic Retinopathy Study Research Group. Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report number 19[J]. Arch Ophthalmol, 1995, 113(9): 1144-1155.
[10] DOFT B H, BLANKENSHIP G W. Single versus multiple treatment sessions of argon laser panretinal photocoagulation for proliferative diabetic retinopathy[J]. Ophthalmology, 1982, 89(7): 772-779.
[11] KASSOFF A, RAY G, KREPOSTMAN J, et al. Randomized comparison of krypton versus argon scatter photocoagulation for diabetic disc neovascularization: The Krypton Argon Regression Neovascularization Study report number 1[J]. Ophthalmology, 1993, 100(11): 1655-1664.
[12] BROWN D M, NGUYEN Q D, RUBIO R G, et al. Ranibizumab for diabetic macular edema (DME): 24-month efficacy and safety results of RISE-a phase 3 randomized controlled trial[J]. Invest Ophthalmol Vis Sci, 2011, 52(14): 6647.
[13] 赵敏婕, 郑志. 抗血管内皮生长因子药物治疗糖尿病视网膜病变的研究进展[J]. 中华眼视光学与视觉科学杂志, 2016, 18(9): 573-576.
[14] Writing Committee for the Diabetic Retinopathy Clinical Research Network, GROSS J G, GLASSMAN A R, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial [J]. JAMA, 2015, 314(20): 2137-2146.
[15] AREVALO J F, GARCIA-AMARIS R A. Intravitreal bevacizumab for diabetic retinopathy[J]. Curr Diabetes Rev, 2009, 5(1): 39-46.
[16] 陈小红, 王云鹏, 陈梅珠. VEGF在糖尿病性视网膜病变发病机制中的作用及抗VEGF治疗新进展[J]. 眼科新进展, 2015, 35(7): 692-696.
[17] LEVIN A M, RUSU I, ORLIN A, et al. Retinal reperfusion in diabetic retinopathy following treatment with anti-VEGF intravitreal injections[J]. Clin Ophthalmol, 2017, 11: 193-200.
[18] IP M S, DOMALPALLY A, HOPKINS J J, et al. Long-term effects of ranibizumab on diabetic retinopathy severity and progression[J]. Arch Ophthalmol, 2012, 130(9): 1145-1152.
[19] 崔蕾, 卢海. 眼内液中PEDF、VEGF含量变化对糖尿病视网膜病变的意义[J]. 国际眼科杂志, 2007, 7(1): 23-26.
[20] OLSEN T W. Anti-VEGF pharmacotherapy as an alternative to panretinal laser photocoagulation for proliferative diabetic retinopathy[J]. JAMA, 2015, 314(20): 2135-2136.
[21] Blankenship G W. Fifteen-year argon laser and xenon photocoagulation visual results of Bascom Palmer Eye Institute’s patients participating in the Diabetic Retinopathy Study[J]. Trans Am Ophthalmol Soc, 1990, 88: 179-185.