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目的对有严重活动性的增生性糖尿病性视网膜病变患者术前眼内注射Bevacizumab(Avastin)的安全性和有效性进行评价。方法采用前瞻性非对照研究。增生性糖尿病视网膜病变入选标准:①牵引性视网膜脱离;②牵引性-孔源性视网膜脱离;③牵引性视网膜脱离合并玻璃体积血。排除标准:①曾患有血管栓塞性疾病(如脑梗塞);②曾行玻璃体切除术。所有患眼均在行玻璃体切除术前7天接受眼内注药术,向玻璃体腔内注射2.5mg(0.1mL)Bevacizumab(Avastin)。主要观察指标是手术并发症的变化,如术中出血情况的变化、剥膜的难易程度、手术持续时间的改变等;术后早期主要观察眼内出血、纤维蛋白渗出和虹膜红变发生情况;其次是术后6个月时的最佳矫正视力及视网膜解剖复位情况。结果30例(34眼)31~79岁患有严重活动性的增生性糖尿病性视网膜病变患者入选。术中发现所有患眼眼内新生血管膜明显萎缩,术中剥膜时出血量明显减少,手术时间相对缩短,硅油使用频率减少;术后早期并发症亦明显减少。所有患者最后一次随访时最佳矫正视力明显好于术前(P<0.01),并且视网膜均解剖复位。结论对于严重活动期增生性糖尿病性视网膜病变患者术前眼内注射Bevaci-zumab(Avastin)安全有效,可明显减少新生血管和术中出血。但该药物手术前使用的最佳时间尚待进一步研究。
Objective To evaluate the safety and efficacy of preoperative intraocular injection of Bevacizumab (Avastin) in patients with severe active proliferative diabetic retinopathy. Methods A prospective, non-controlled study was performed. Proliferative diabetic retinopathy selection criteria: ① traction retinal detachment; ② traction - rhegmatogenous retinal detachment; ③ traction retinal detachment with vitreous hemorrhage. Exclusion criteria: ① have suffered from vascular embolism (such as cerebral infarction); ② had undergone vitrectomy. All affected eyes underwent intraocular instillation 7 days prior to the vitrectomy and intravitreal injection of 2.5 mg (0.1 mL) of Bevacizumab (Avastin). MAIN OUTCOME MEASURES: Changes of operative complications, such as intraoperative bleeding, ease of stripping, and duration of surgery; early postoperative observation of intraocular hemorrhage, fibrin exudation and iris reddening ; Followed by best corrected visual acuity and retinal anatomy at 6 months after surgery. Results Thirty (34 eyes) patients with proliferative diabetic retinopathy who were 31-79 years old with severe activity were enrolled. Intraoperative intraocular neovascularization was found in all patients with atrophy, blood loss during surgery was significantly reduced, the operation time is relatively shortened, the use of silicone oil to reduce the frequency of postoperative complications also significantly reduced. The best corrected visual acuity was significantly better at the last follow-up in all patients (P <0.01), and the retina was dissected. Conclusion Preoperative intraocular injection of Bevaci-zumab (Avastin) in patients with proliferative diabetic retinopathy is safe and effective, which can significantly reduce the neovascularization and intraoperative bleeding. However, the best time to use the drug before surgery is for further study.