康柏西普联合曲安奈德球内注射治疗糖尿病黄斑水肿
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摘要
目的:探讨康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿的疗效。方法:回顾性队列研究。合并黄斑水肿的糖尿病患者40例43眼,治疗前记录BCVA、IOP和OCT检查。根据治疗方式分为两组,A组患者给予玻璃体腔注射康柏西普联合曲安奈德治疗,B组给予玻璃体腔注射康柏西普治疗。分别于治疗后1d,1、4、8、12、24wk记录BCVA、IOP和CMT及并发症等情况。结果:A组治疗后不同时间点的视力与治疗前(0.83±0.03)相比均有差异(P<0.05),治疗8wk时达到最佳视力(0.23±0.04);治疗后CMT与治疗前(612.4±47.6μm)有差异(P<0.05);24wk内平均注射次数2.7次。B组治疗后不同时间点视力与治疗前(0.79±0.09)有差异(P<0.05),治疗4wk时达到最佳视力(0.25±0.06)。治疗后CMT与治疗前(597.8±62.4μm)有差异(P<0.05),24wk内平均注射次数3.6次。两组患者第一针与第二针治疗间隔时间有差异(P<0.05)。两组患者治疗前后眼压无差异(P>0.05)。结论:康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿安全、有效、见效快,但疗效更持久,且可降低打针频率。
·AIM: To investigate the therapeutic effects of intravitreal injection of conbercept combined with triamcinolone acetonide for diabetic macular edema(DME).·METHODS: This retrospective cohort study comprised of 43 eyes in 40 patients who suffered from DME. There were 2 groups, groups A and B, according to the different therapies. Group A(22 eyes of 21 patients) were treated with intravitreal injection of 0.5 mg/0.05 mL conbercept and 2 mg triamcinolone acetonide(TA). Group B(21 eyes of 19 patients) were treated with intravitreal injection of 0.5 mg/0.05 mL conbercept. All the patients were followed up to 24 wk. The best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT) and complications were recorded and analyzed prior to operation and 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk after operation.·RESULTS:Group A: the BCVA of 22 eyes of 21 patients treated with intravitreal injection of 0.5 mg/0.05 mL and 2 mg triamcinolone acetonide on 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk were significantly different from that(LogMAR 0.83±0.03) prior to treatment(P<0.05), and the BCVA was achieved at 8 wk(LogMAR 0.23±0.04). The CMT were significantly different from that(612.4±47.6μm) prior to treatment(P<0.05). The average number of injections was 2.7 injections within 24 wk; Group B: the VA of 21 eyes in 21 patients treated with intravitreal injection of 0.5 mg/0.05 mL on 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk were significantly different from that(LogMAR 0.79±0.09) prior to treatment(P<0.05), and the BCVA was achieved at 4 wk(LogMAR 0.25±0.06). The CMT were significantly different from that(597.8±62.4μm) prior to treatment(P<0.05). The average number of injections was 3.6 injections within 24 wk.There was statistically significant difference in the interval between the first and second injections of two groups(P<0.05). There were no significant difference in IOP.·CONCLUSION: In summary, combined intravitreal injection of conbercept and TA is a safe and effective treatment for DME. The effect is more durable and the injection frequency can be reduced. The combination of anti-VEGF and corticosteroids may be an effective treatment for DME.
·AIM: To investigate the therapeutic effects of intravitreal injection of conbercept combined with triamcinolone acetonide for diabetic macular edema(DME).·METHODS: This retrospective cohort study comprised of 43 eyes in 40 patients who suffered from DME. There were 2 groups, groups A and B, according to the different therapies. Group A(22 eyes of 21 patients) were treated with intravitreal injection of 0.5 mg/0.05 mL conbercept and 2 mg triamcinolone acetonide(TA). Group B(21 eyes of 19 patients) were treated with intravitreal injection of 0.5 mg/0.05 mL conbercept. All the patients were followed up to 24 wk. The best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT) and complications were recorded and analyzed prior to operation and 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk after operation.·RESULTS:Group A: the BCVA of 22 eyes of 21 patients treated with intravitreal injection of 0.5 mg/0.05 mL and 2 mg triamcinolone acetonide on 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk were significantly different from that(LogMAR 0.83±0.03) prior to treatment(P<0.05), and the BCVA was achieved at 8 wk(LogMAR 0.23±0.04). The CMT were significantly different from that(612.4±47.6μm) prior to treatment(P<0.05). The average number of injections was 2.7 injections within 24 wk; Group B: the VA of 21 eyes in 21 patients treated with intravitreal injection of 0.5 mg/0.05 mL on 1 d, 1 wk, 4 wk, 8 wk, 12 wk and 24 wk were significantly different from that(LogMAR 0.79±0.09) prior to treatment(P<0.05), and the BCVA was achieved at 4 wk(LogMAR 0.25±0.06). The CMT were significantly different from that(597.8±62.4μm) prior to treatment(P<0.05). The average number of injections was 3.6 injections within 24 wk.There was statistically significant difference in the interval between the first and second injections of two groups(P<0.05). There were no significant difference in IOP.·CONCLUSION: In summary, combined intravitreal injection of conbercept and TA is a safe and effective treatment for DME. The effect is more durable and the injection frequency can be reduced. The combination of anti-VEGF and corticosteroids may be an effective treatment for DME.
引文
1 Das A, Stroud S, Mehta A, et al. New treatments for diabetic retinopathy. Diabetes Obes Metab 2015;17(3):219-230
2 Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016;44(4):260-277
3 Boyer DS, Hopkins JJ, Sorof J, et al. Anti-vascular endothelial growth factor therapy for diabetic macular edema. Ther Adv Endocrinol Metab 2013;4(6):151-169
4 Homayoun N, Saeed K, Hamid A, et al. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018;13(2):158-169
5 Colin A. McCannel. 2018-2019 BCSC (Basic and Clinical Science Course). American Academy of Ophthalmology 2018. Section 12: Retina and Vitreous:92-93
6 Jackson TL, Nicod E, Angelis A, et al. PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA: A Systematic Review, Meta-Analysis, and Synthesis of Safety Literature. Retina 2017;37(5):886-895
7 Ziemssen F, Schlottman PG, Lim JI, et al. Initiation of intravitreal aflibercept injection treatment in patients with diabetic macular edema: a review of VIVID-DME and VISTA-DME data. Int J Retina Vitreous 2016;(2):16
8 Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 2015;372(13):1193-1203
9 Joussen AM, Poulaki V, Le ML, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. FASEB J 2004;18(12):1450-1452
10 Campochiaro PA, Brown DM, Pearson A, et al. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology 2011;118(4):626-635
11 Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4mg vs 2mg. Am J Ophthalmol 2006;142(5):794-799
12祝莹,李军,徐少凯.不同剂量IVTA 治疗葡萄膜炎黄斑囊样水肿的疗效观察.国际眼科杂志 2013;13(6):1236-1238
13 Riazi-Esfahani M, Riazi-Esfahani H, Ahmadraji A, et al. Intravitreal bevacizumab alone or combined with 1mg triamcinolone in diabetic macular edema: a randomized clinical trial. Int Ophthalmol 2018;38(2):585-598
14 Bastakis GG, Dimopoulos D, Stavrakakis A, et al. Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema. Eye (Lond) 2018 [Epub ahead of print]
2 Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016;44(4):260-277
3 Boyer DS, Hopkins JJ, Sorof J, et al. Anti-vascular endothelial growth factor therapy for diabetic macular edema. Ther Adv Endocrinol Metab 2013;4(6):151-169
4 Homayoun N, Saeed K, Hamid A, et al. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018;13(2):158-169
5 Colin A. McCannel. 2018-2019 BCSC (Basic and Clinical Science Course). American Academy of Ophthalmology 2018. Section 12: Retina and Vitreous:92-93
6 Jackson TL, Nicod E, Angelis A, et al. PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA: A Systematic Review, Meta-Analysis, and Synthesis of Safety Literature. Retina 2017;37(5):886-895
7 Ziemssen F, Schlottman PG, Lim JI, et al. Initiation of intravitreal aflibercept injection treatment in patients with diabetic macular edema: a review of VIVID-DME and VISTA-DME data. Int J Retina Vitreous 2016;(2):16
8 Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 2015;372(13):1193-1203
9 Joussen AM, Poulaki V, Le ML, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. FASEB J 2004;18(12):1450-1452
10 Campochiaro PA, Brown DM, Pearson A, et al. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology 2011;118(4):626-635
11 Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4mg vs 2mg. Am J Ophthalmol 2006;142(5):794-799
12祝莹,李军,徐少凯.不同剂量IVTA 治疗葡萄膜炎黄斑囊样水肿的疗效观察.国际眼科杂志 2013;13(6):1236-1238
13 Riazi-Esfahani M, Riazi-Esfahani H, Ahmadraji A, et al. Intravitreal bevacizumab alone or combined with 1mg triamcinolone in diabetic macular edema: a randomized clinical trial. Int Ophthalmol 2018;38(2):585-598
14 Bastakis GG, Dimopoulos D, Stavrakakis A, et al. Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema. Eye (Lond) 2018 [Epub ahead of print]