INTRAVITREAL AFLIBERCEPT EFFECTIVELY TREATING TWO PATIENTS WITH DIABETIC MACULAR EDEMA REFRACTORY TO BEVACIZUMAB OR RANIBIZUMAB

兩名糖尿病患之黃斑部水腫經樂舒晴或癌思婷治療無效後以采視明可有效治療

陳彥伊(Yen-Yi Chen) ； 林庭瑄(Ting-Hsuan Lin) ； 王嘉康(Jia-Kang Wang)

《中華民國眼科醫學會雜誌》 55卷 (2016/12) Pp. 80-87

https://doi.org/10.30048/ACTASOS.201612_55.0013

摘要

Purpose: To describe intravitreal aflibercept effectively treating for two cases with diabetic macular edema (DME) refractory to bevacizumab or ranibizumab. Methods: Case Reports. Results: The 54-year-old diabetic man complained of blurred vision in the right eye. His best corrected visual acuity (BCVA) was 20/60. Fundus fluorescein angiography showed mild non-proliferative diabetic retinopathy and clinical significant macular edema. Optical coherence tomography demonstrated cystoid macular edema with central foveal thickness (CFT) up to 354 μm. The case underwent 1.25 mg/0.05 mL of single intravitreal bevacizumab (IVB). Aggravated DME was found one month after IVB, as CFT increasing to 440 μm and BCVA reducing to 20/100. One month following two subsequent monthly IVB and posterior subtenon triamcinolone acetoine (PSTA) 20 mg, CFT further increased to 618 μm and BCVA decreased to 20/400. Because the patient with DME was refractory to bevacizumab, the patient agreed to receive 2 mg/0.05 mL of three monthly intravitreal aflibercept (IVA). His BCVA improved to 20/50 at month 3 following the last injection. The CFT dramatically decreased to 256 μm at month 3. The second case is a 62-year-old diabetic man with BCVA 20/400 in the right eye. Optical coherence tomography demonstrated CFT up to 502 μm. He underwent three monthly 0.5 mg/0.05 mL of intravitreal ranibizumab (IVR). His BCVA improved to 20/60 and CFT decreased to 296 μm. However, the following three monthly IVR paradoxically caused BCVA reducing to 20/125 and CFT increasing to 506 μm. Considering development of tachyphylaxis to ranibizumab, the treatment switched to aflibercept. After three monthly IVA, DME ameliorated as CFT down to 291 μm and BCVA up to 20/50. There was no associated systemic or ocular adverse effect in both cases. Conclusions: Intravitreal aflibercept possibly benefits for macular edema with suboptimal results on ranibizumab or bevacizumab in diabetic patients.

關鍵字

Intravitreal injection ； aflibercept ； diabetic macular edema ； bevacizumab ； ranibizumab

並列摘要

目的：描述兩名糖尿病患之黃斑部水腫經樂舒晴或癌思婷治療無效後以采視明可有效治療之個案。方法：病例報告。結果：一位54歲男性糖尿病病患右眼視力為20/60，眼底螢光血管攝影可以見糖尿病視網膜病變併嚴重黃斑部水腫，經黃斑部雷射，眼內注射癌思婷，或結膜下注射類固醇，視力無改善且眼底斷層掃描顯示黃斑部水腫，黃斑部中心厚度從354微米持續惡化至618微米，在注射三次采視明之後，病患視力可進步至20/50且黃斑部水腫明顯改善，黃斑部中心厚度降至256微米。另一位62歲男性糖尿病病患右眼視力只有20/400，眼底斷層掃描顯示黃斑部水腫，黃斑部中心厚度為502微米，經三次眼內注射樂舒晴之後，黃斑部中心厚度可進步至296微米，但再經三次眼內注射樂舒晴後，黃斑部中心厚度又增厚至506微米，疑似對樂舒晴產生快速抗藥反應(tachyphylaxis)，改使用采視明三次眼內注射後，黃斑部中心厚度減至291微米，視力可進步至20/50。結論：我們認為若糖尿病患之黃斑部水腫經樂舒 晴或癌思婷眼內注射治療無法達到最佳效果後，使用采視明可能使視力進步，明顯改善黃斑部水腫。