Intravitrealna primena bevacizumaba sa ili bez laser-tretmana u poređenju sa laser-tretmanom kao primarnim načinom lečenja dijabetesnog edema makule

  • Sandra P Jovanović Clinic for Eye Diseases, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Vladimir Čanadanović Clinic for Eye Diseases, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Ana Sabo Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Zorka Grgić Clinic for Eye Diseases, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Milena Mitrović Endocrinology, Diabetes and Metabolic Disorders Clinic, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Dušan Rakić Department of Mathematics, Faculty of Technology, University of Novi Sad, Novi Sad, Serbia
DOI: https://doi.org/10.2298/5830
Ključne reči: diabetic retinopathy||, ||dijabetesna retinopatija, macular edema||, ||žuta mrlja, edem, ophthalmologic surgical procedures||, ||hirurgija, oftalmološka, procedure, vascular endothelial growth factors||, ||faktori rasta endotela krvnih sudova, light coagulation||, ||fotokoagulacija, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/Cilj. U sklopu dijabetesne retinopatije (DR) jedan od najranijih razloga koji dovodi do pada oštrine vida je dijabetesni makularni edem (DME). Cilj rada bio je utvrđivanje efikasnosti lečenja DME intravitrealnom primenom inhibitora vaskularnog endotelnog faktora rasta (VEGF) samostalno ili u sklopu kombinovanog lečenja laserfotokoagulacijom makule tipa fokal/grid i poređenje sa konvencionalnim lečenjem makule laserom. Metode. Istraživanje je sprovedeno kao prospektivna, randomizirana klinička studija na 72 bolesnika (120 lečena oka) sa različitim stepenom DR i DME. Lečenje DME podrazumevalo je intavitrealnu primenu inhibitora VEGF bevacizumaba (Avastin®) sa ili bez primene lasera. Lek je primenjivan u dozi 1,25 mg u 0,05 mL u razmacima od 4 do 6 nedelja. Laserfotokoagulacija vršena je u kontrolnoj grupi kao primarni vid terapije ili kao dopuna prethodnog lečenja makule aplikacijom bevacizumaba nakon 4–6 nedelja od poslednje doze ukoliko nije došlo do poboljšanja centralne debljine makule (CMT).
Rezultati. Prosečna vrednost smanjenja CMT za oči (n = 31) lečene samo bevacizumabom iznosila je 162,23 µm, za oči lečene kombinovanom metodom (n = 53) redukcija CMT iznosila je 124,24 µm; statistički značajno u obe grupe p < 0,05. Laserfotokoagulacija makule kod bolesnika/očiju sa kombinovanim lečenjem statistički značajno je doprinosila dodatnom redukovanju CMT na osnovu uporednog t-testa (366,28 prema 323,0 µm; p < 0,05). U našoj studiji postignuto prosečno poboljšanje oštrine vida u grupi očiju lečenih intravitrealnom primenom bevacizumaba iznosilo je 0,161 logMAR, kod očiju sa kombinovanim lečenjem, 0,093 logMAR, statistički značajno u obe grupe p < 0,05. Uticaj laserfotokoagulacije, samostalno, na oštrinu vida i CMT bio je bez statističke značajnosti. Zaključak. Lečenje DME intravitrealnim aplikacijama bevacizumaba samostalno ili u sklopu kombinovanog lečenja je efikasnije nego konvencionalno lečenje makule laserom, kako anatomski tako i funkcionalno.

Biografija autora

Sandra P Jovanović, Clinic for Eye Diseases, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Ass. mr sci. med. dr Sandra Jovanović, asistent sa magistraturom, načelnik odeljenja bolesti zadnjeg segmenta oka

Reference

Klein R. Retinopathy in a population-based study. Trans Am Ophthalmol Soc 1992; 90: 561−94.

Kempen JH, O'Colmain BJ, Leske MC, Haffner SM, Klein R, Moss SE, et al. The prevalence of diabeticretinopathy among adults in the United States. Arch Ophthalmol. 2004; 122(4): 552−63.

Orchard TJ, Dorman JS, Maser RE, Becker DJ, Drash AL, Ellis D, et al. Prevalence of complications in IDDM by sex and dura-tion. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes 1990; 39(9): 1116−24.

Girach A, Lund-Andersen H. Diabetic macular oedema: a clinical overview. Int J Clin Pract 2007; 61(1): 88−97.

Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T, Girach A. Epidemiology of diabetic retinopathy and macular oedema: a systematic review. Eye 2004; 18(10): 963−83.

Gardner TW, Antonetti DA, Barber AJ, LaNoue KF, Levison SW. Diabetic retinopathy: more than meets the eye. Surv Ophthal-mol 2002; 47(Suppl 2): S253−62.

Cai J, Boulton M. The pathogenesis of diabetic retinopathy: old concepts and new questions. Eye (Lond) 2002; 16(3): 242−60.

Ferrara N. Role of vascular endothelial growth factor in phys-iologic and pathologic angiogenesis: therapeutic implications. Semin Oncol 2002; 29(6 Suppl 16): 10−4.

Takahashi H, Shibuya M. The vascular endothelial growth factor (VEGF)/VEGF receptor system and its role under physiolog-ical and pathological conditions. Clin Sci 2005; 109(3): 227−41.

Scott IU, Edwards AR, Beck RW, Bressler NM, Chan CK, Elman MJ, et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthalmology 2007; 114(10): 1860−7.

Fong DS, Strauber SF, Aiello LP, Beck RW, Callanan DG, Danis RP, et al. Writing Committee for the Diabetic Retinopathy Clinical Research Network. Comparison of the modified Early Treatment Diabetic Retinopathy Study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol 2007; 125(4): 469−80.

Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110(9): 1677−82.

Faghihi H, Esfahani MR, Harandi ZA, Madani SH. Intravitreal bevacizumab vs. combination of intravitreal bevacizumab plus macular photocoagulation in clinically significant diabetic macular edema: 6 months results of a randomized clinical trial. Iranian J Ophthalmol 2010; 22(1): 21−6.

Rajendram R, Fraser-Bell S, Kaines A, Michaelides M, Hamilton RD, Esposti SD, et al. A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3. Arch Ophthalmol 2012; 130(8): 972−9.

Haritoglou C, Kook D, Neubauer A, Wolf A, Priglinger S, Strauss R, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina 2006; 26(9): 999−1005.

Kook D, Wolf A, Kreutzer T, Neubauer A, Strauss R, Ulbig M, et al. Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema. Retina 2008; 28(8): 1053−60.

Mehta S, Blinder KJ, Shah GK, Kymes SM, Schlief SL, Grand MG. Intravitreal bevacizumab for the treatment of refractory dia-betic macular edema. Ophthalmic Surg Lasers Imaging 2010; 41(3): 323−9.

Roh MI, Byeon SH, Kwon OW. Repeated intravitreal injection of bevacizumab for clinically significant diabetic macular edema. Retina 2008; 28(9): 1314−8.

Arevalo J, Fromow-Guerra J, Quiroz-Mercado H, Sanchez JG, Wu L, Maia M, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Col-laborative Retina Study Group at 6-month follow-up. Oph-thalmology 2007; 114(4): 743−50.

Kumar A, Sinha S. Intravitreal bevacizumab (Avastin) treatment of diffuse diabetic macular edema in an Indian population. In-dian J Ophthalmol 2007; 55(6): 451−5.

Lee SJ, Kim ET, Moon SY. Intravitreal bevacizumab alone ver-sus combined with macular photocoagulation in diabetic mac-ular edema. Korean J Ophthalmol 2011; 25(5): 299−304.

Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 10 (2015)
Rubrika
Originalni članak