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玻璃体内注射贝伐单抗与激光治疗1型早产儿视网膜病随访致4岁比较:荧光素血管造影结果

Lepore, D., Quinn, G.E., Molle, F., et al.

期刊名称:Ophthalmology

卷期:2018年第125卷第2期

摘要

摘要:目的:比较在1型早产儿视网膜病变(ROP)中使用常规激光消融治疗的贝伐珠单抗治疗4岁时的结构性结果。

设计:单因子试验、随机试验、对照试验。

参与者:从200991日至2012331日,在罗马天主教大学重症监护病房内的新生儿,所有这些婴儿都有1号区域的1型早产儿视网膜病变。

方法:21个婴儿(42),随机1只眼接受0.5 mg贝伐珠玻璃体内单抗注射;另一只眼睛接受传统的激光光切除治疗。平均4年时间内进行了数字视网膜成像和荧光血管造影(FA),并在治疗时和9个月后进行了随访。

主要结果测量:2名专家检查荧光素血管造影,记录视网膜和脉络膜的发现。

结果:在4岁的20例贝伐单抗治疗眼中,均显示周围(无血管区、血管渗漏、分流、异常血管分支、结皮)或后极(超荧光病变,无小血管无血管区)异常。这些病变在大多数接受激光治疗眼内没有观察到。在19只被激光治疗的眼睛中,有1只眼睛发现了渗漏,3只眼睛发现了分流和缠结,3只眼睛发现了黄斑异常。

结论: 荧光素血管造影显示,对于视网膜病变急性期,相比激光治疗,对眼部有潜在严重和长期的影响更常见于贝伐珠单抗治疗。

PURPOSE:To compare structural outcome at age 4 years of eyes treated with intravitreal injection of bevacizumab with fellow eyes treated with conventional laser photoablation in type 1 retinopathy of prematurity (ROP).DESIGN:Single, randomized, controlled trial.PARTICIPANTS:All inborn babies with type 1 zone 1 ROP at the Neonatal Intensive Care Unit of the Catholic University, Rome, from September 1, 2009, to March 31, 2012.METHODS:In 21 infants (42 eyes), 1 eye was randomized to receive an intravitreal injection of 0.5 mg bevacizumab; the fellow eye underwent conventional laser photoablation. Digital retinal imaging and fluorescein angiography (FA) were performed at an average of 4 years after treatment in follow-up after these studies performed at treatment and 9 months.MAIN OUTCOME MEASURES:Fluorescein angiograms were examined by 2 experts to document retinal and choroidal findings.RESULTS:Among the 20 bevacizumab-treated eyes available at 4 years of age, all showed abnormalities at the periphery (avascular area, vessel leakage, shunts, abnormal vessel branching, and tangles) or the posterior pole (hyperfluorescent lesions, absence of foveal avascular zone). These lesions were not observed in the majority of the lasered eyes. Among the 19 laser-treated eyes, leakage was noted in 1 eye, shunts and tangles were noted in 3 eyes, and macular abnormalities were noted in 3 eyes.CONCLUSIONS:Fluorescein angiography has shown potentially serious and long-term ocular effects that are present more commonly after treatment with bevacizumab for acute-phase ROP than after laser.


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