Tomographic Changes in Diabetic Macular Edema Managed by Intravitreal Bevacizumab with or without Posterior Subtenon Injection of Triamcinolone

單獨玻璃體內注射癌思停或合併後筋膜下注射類固醇治療糖尿病黃斑部水腫之眼底光學同調斷層掃描之變化

王嘉康(Jia-Kang Wang)

《中華民國眼科醫學會雜誌》 50卷2期 (2011/06) Pp. 274-282

https://doi.org/10.30048/ACTASOS.201106.0008

摘要

目的：在於探討對於糖尿病黃斑部水腫，以玻璃體內注射癌思停及後筋膜下注射類固醇治療之短期成效。方法：這是一個回溯性、比較性、非隨機之研究。自2008年1月至2009年12月，收集糖尿病黃斑部水腫患者，到院前並無任何治療。患眼共分兩組，IVB組為眼內注射1.25mg癌思停（55隻眼），IVB／PST組為眼內注射1.25mg癌思停併後筋膜下注射類固醇20mg（46隻眼）。測量注射一次後，1、2、3、及6個月後，中央窩厚度、及中央黃斑部體積之變化，並記錄併發症之發生，組內及組間之差異分別以方法統計之。結果：中央窩厚度、及中央黃斑部體積在注射1、2、3、及6個月後兩組皆顯著降低（p＜0.05），但於6個月後並無顯著降低（p＞0.05）。注射前及注射一次1、2、3、及6個月後，中央窩厚度、及中央黃斑部體積在兩組間並無統計上之差別。在IVB組55隻眼中有3隻眼原有纖維化增生，注射後發生牽引性視網膜玻璃。並無其他眼部併發症。結論：玻璃體內注射癌思停，不論有無合併後筋膜下注射類固醇，於3個月內注射一次，治療糖尿病黃斑部水腫，都是相同有效。但增加後筋膜下注射類固醇並無增加治療效果，且玻璃體內注射癌思停仍有潛在之危險性。

並列摘要

Purpose: To investigate the tomographic efficacy of intravitreal bevacizumab (IVB) combined with posterior subtenon triamcinolone (PST) in patients with diabetic macular edema.Methods: This is a retrospective, comparative, and nonrandomized study. From January 2008 to December 2009, patients with diabetic macular edema but without prior macular laser or any intervention were enrolled. The eyes were divided into one of two study arms: the IVB group, patients who received 1.25 mg of intravitreal bevacizumab (55 eyes); and the IVB/PST group, patients who received 1.25 mg of intravitreal bevacizumab and 20 mg of posterior subtenon triamcinolone (46 eyes). Primary outcome measures included change in central foveal thickness (CFT) in 1 mm and central macular volume (CMV) in 5 mm of diameter by spectral-domain optic coherence tomography 1, 2, 3 and 6 months after one injection. Complications after injections were recorded. The intra-group difference was compared with Wilcoxon sign-rank test, and the inter-group difference was compared with Wilcoxon rank-sum test.Results: Both CMV and CFT were significantly reduced 1, 2 and 3 months after injections in both groups (p ＜ 0.05), but not significantly decreased 6 months after injections (p ＞ 0.05). There was no significant difference in CMV and CFT at baseline or at 1, 2, 3 and 6 months following injections between the two groups. There were 3 eyes (3/55, 5.5%) with proliferative diabetic retinopathy and active fibrovascular proliferation having subsequent tractional retinal detachment in the IVB group. There were no eyes with elevated intraocular pressure, retinal detachment, and infectious endophthalmitis in the two groups.Conclusions: Both regimens (IVB and IVB/PST) by single injection were useful in treating diabetic macular edema within 3 months. Posterior subtenon triamcinolone did not prolong or enhance the effect of intravitreal bevacizumab for managing diabetic macular edema. Potential complications should be addressed after intravitreal bevacizumab.

並列關鍵字

intravitreal injection ； bevacizumab ； triamcinolone ； diabetic macular edema