Ranibizumab

摘要： 目的观察抗血管内皮生长因子(VEGF)药物治疗湿性老年性黄斑变性(wAMD)的效果及对房水和血清白细胞介素-8(IL-8)、人白血病抑制因子(LIF)、基质细胞衍生因子1-α(SDF1-α)、VEGF水平的影响。方法选取2016年5月—2020年8月90例(108眼)wAMD为研究对象,其中68例(81眼)行玻璃体腔注射Ranibizumab治疗设为观察组,22例(27眼)行保守治疗设为保守组,并以拟行白内障手术20例(20眼)设为对照组。检测并比较wAMD患者治疗前后以及对照组术前房水和血清IL-8、LIF、SDF1-α、VEGF水平。检测并比较wAMD患者治疗前后眼压值、最佳矫正视力及黄斑中心凹视网膜厚度(CRT)。结果观察组与保守组治疗前后眼压值比较差异无统计学意义(P>0.05);观察组治疗后最佳矫正视力优于治疗前及保守组,黄斑CRT小于治疗前及保守组(P<0.05)。观察组治疗前房水和血清IL-8、LIF、SDF1-α、VEGF-A、VEGF-D水平高于对照组(P<0.05);多因素Logistic回归分析显示,治疗前房水和血清IL-8、LIF、SDF1-α、VEGF-A、VEGF-D水平与wAMD的发生具有显著相关性(P<0.05,P<0.01)。观察组治疗后房水和血清IL-8、LIF、SDF1-α、VEGF-A、VEGF-D水平较治疗前降低(P<0.05)。结论玻璃体腔注射Ranibizumab治疗wAMD效果显著,可能与其能有效降低患者房水和血清IL-8、LIF、SDF1-α、VEGF-A、VEGF-D水平有关。

摘要： BACKGROUND Diabetes is a serious public health concern in China,with 30%of patients developing retinopathy,and diabetic macular edema(DME)having the biggest impact on vision.High blood glucose level can cause retinal cell hypoxia,thus promoting vascular endothelial growth factor(VEGF)formation and increasing vascular permeability,which induces DME.Moreover,cell hypoxia can accelerate the rate of apoptosis,which leads to the aging of patients.In severe cases,optic cell apoptosis or retinal fibrosis and permanent blindness may occur.AIM To investigate and compare the efficacy,mechanism,and differences between two anti-VEGF drugs(Compaq and ranibizumab)in DME patients.METHODS Ninety-six patients with DME who attended our hospital from April 2018 to February 2020 were included and randomly divided into two groups(Compaq group and ranibizumab group).The groups received vitreal cavity injections of 0.5 mg Compaq and 0.5 mg ranibizumab,respectively,once a month.The best corrected visual acuity(BCVA),intraocular pressure(IOP),macular retinal thickness(CMT),macular choroidal thickness(SFCT),foveal no perfusion area(FAZ),superficial capillary density,deep capillary density,treatment effect,and adverse reactions were compared before and after treatment and between the two groups.RESULTS Before treatment and 1-mo post-treatment,there was no statistically significant difference in the estimated BCVA in both groups(P>0.05).BCVA decreased in the Compaq group 3 mo after treatment,and the difference was statistically significant(P0.05).Before treatment and 1-mo post-treatment,there was no statistically significant difference in the estimated CMT,SFCT,or FAZ in either group(P>0.05).CMT and SFCT values decreased in the Compaq group 3 mo post-treatment,and the difference was statistically significant(P0.05).Marked efficient,effective,and invalid rates were 70.83%and 52.08%,27.08%and 39.58%,and 2.08%and 8.33%in the Compaq and ranibizumab groups,respectively.The differences between the two groups were statistically significant(P<0.05).CONCLUSION Anti-VEGF drugs can effectively improve CMT and SFCT,without affecting microcirculation,thus providing an effective and safe treatment for patients with DME.

摘要： BACKGROUND Waldenström macroglobulinemia(WM)is a distinct clinicopathologic entity characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M(IgM)in the blood,and patients may present with symptoms related to the infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood.Funduscopic abnormalities were noted in some of the patients due to hyperviscosity or other retinal lesions.Optical coherence tomography angiography(OCTA)as a noninvasive imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels,which might be useful for diagnosing patients with WM-associated retinopathy.CASE SUMMARY The patient was a 67-year-old man who presented with sudden visual disturbance in both eyes.Ophthalmic tests showed that best corrected visual acuity(BCVA)for this patient was 20/100 in the right eye and 20/1000 in the left eye.Fundus examination,optical coherence tomography(OCT),and OCTA revealed substantial bilateral optic disc edema,dilated and tortuous retinal veins,and diffuse intraretinal blot hemorrhages and edema which were consistent with bilateral central retinal vein occlusion(CRVO).Meanwhile,remarkable bilateral serous macular detachments(SMD)were noticed on OCT.Systemic examinations showed that the patient had anemia and extremely high level of monoclonal IgM and infiltration of clonal lymphoplasmacytic cells in bone marrow.The diagnosis of WM with hyperviscosity and retinopathy was made based on the clinical manifestation and laboratory findings.He was subsequently treated with intravitreal ranibizumab injection,plasmapheresis,and bortezomib plus rituximab with dexamethasone.Six months after treatments,the central macular volume decreased by 16.1%in the right eye and 28.6%in the left eye on OCT,and the patient’s BCVA was improved to 20/60 in the right eye and 20/400 in the left eye.Very good partial response was obtained after systemic treatment.CONCLUSION WM may affect visual function and present as bilateral CRVO.OCTA can show characteristic changes in both retina and choroid vasculatures,which might be of great value for diagnosing or following patients with WM retinopathy.Intravitreal anti-vascular endothelial growth factor treatment combined with systemic therapy might be beneficial for WM patients with retinopathy(SMD and CRVO).

摘要： 目的 探讨Ranibizumab(雷珠单抗)玻璃体腔注射辅助玻璃体切割术对增殖性糖尿病视网膜病变(PDR)合并新生血管性青光眼(NVG)的临床效果.方法 对我院眼科2013年5月-2016年2月诊治的PDR合并NVG的53例患者(53只眼)的临床资料进行回顾分析,在患者知情同意的情况下,将患者按照不同的治疗方法分为观察组和对照组,其中28例(28只眼)在玻璃体切割术前行玻璃体腔注射Ranibizumab作为观察组,25例(25只眼)只行玻璃体切割作为对照组.观察记录患者的术中及术后情况,并进行组间对比分析.结果 与对照组比较,观察组患者的手术时间显著缩短,且切割术中新生血管出血的次数、器械交换次数和电凝次数均显著少于对照组,差异有统计学意义(P＜0.05);术中观察组出血、医源性视网膜裂孔及纤维血管残留发生率均低于对照组,其中两组轻度出血发生率差异有统计学意义(P＜0.05);术后一个月,观察组CRT显著低于对照组,BCVA显著高于对照组(P＜0.05);术后一周两组眼压较术前显著升高,对照组变化尤为显著,术后一个月两组眼压均有所降低,其中观察组显著低于对照组(P＜0.05),但两组与术前比较差异无统计学意义(P＞0.05);术后观察组玻璃体腔再出血发生率显著低于对照组(P＜0.05).结论 Ranibizumab玻璃体腔注射辅助玻璃体切割术治疗PDR合并NVG,可有效降低术中出血次数,缩短手术时间,提高BCVA水平,降低术中及术后并发症发生率.

摘要： 目的 评估复合小梁切除术联合玻璃体腔内注射Ranibizumab以及全视网膜光凝术在新生血管性青光眼治疗的有效性及安全性.方法 研究对象为方便选取2015年5月-2016年2月于昆明医科大学第一附属医院眼科就诊的新生血管性青光眼患者20例(22只眼),入选患者均行玻璃体腔注射Ranibizumab(0.5 mg/0.05 mL),待虹膜新生血管消退或萎缩后,再行复合小梁切除术,以穹窿部为基底作结膜瓣,术中联用丝裂霉素C(0.4 mg/mL,3~5 min).根据患者屈光介质情况术前或术后行全视网膜光凝.小梁切除术后随访6个月,观察视力、眼压和手术并发症情况.结果 新生血管性青光眼的原因包括视网膜静脉阻塞,其中中央静脉阻塞(11只眼)、分支静脉阻塞(6只眼),糖尿病视网膜病变(5只眼).玻璃体腔注药后1 d,新生血管开始逐渐消退,2~5 d 22只眼新生血管全部消退.术前眼压平均为(42.27±2.95)mmHg,术后1个月平均眼压降至(12.05±2.78)mmHg,术后3个月(14.22±2.70)mmHg,术后6个月降至(15.09±4.21)mmHg,术后各随访时间点眼压与术前相比均差异有统计学意义(P0.05).术前抗青光眼药物的使用数量为(3.14±0.71)种,术后数量降至(0.82±1.14)种.完全成功12眼(54.5%),部分成功6眼(27.3%),总手术成功率81.8%(18/22).手术并发症:术后浅前房4例,经散瞳药物治疗2周内恢复正常;前房积血2例;脉络膜脱离1例,药物治疗后恢复;无其他严重并发症出现.结论 复合小梁切除术联合玻璃体腔注射Ranibizumab和全视网膜光凝术是治疗新生血管性青光眼的安全而有效的方式.

摘要： This study was designed to explore the prevalence of fibrovascular proliferation not regressed in zone Ⅱ stage 3 retinopathy of prematurity(ROP)after initial intravitreal ranibizumab(IVR)injections and to explore the possible influence factors.Fifty-seven patients(108 eyes)with ROP who underwent intravitreal injection of ranibizumab between January 2013 and July 2014 participated in the retrospective study.Based on regress of fibrovascular tissue or not after initial injections of ranibizumab,eligible eyes were divided into two groups.Data was collected and analyzed with SPSS 16.0.In the study,108 eyes of 57 patients(18 females,39 males)underwent initial intravitreal injection.The mean birth weight was 1,440.0±357.7 g and the mean gestational age was 30.5±2.0 weeks.Eight of 57(14.0%)patients showed unfavorable fibrovascular proliferation after initial ranibizumab treatment within 2 weeks.Among them,11 eyes were controlled by further laser treatment and 3 eyes underwent vitrectomy.The difference of occurrence rate in hemorrhage between the two groups was significant(P<0.030),and the unfavorable group required more laser treatment(P<0.001).The incidence of unfavorable fibrovascular proliferation was relatively high,and intraocular hemorrhage was possibly associated with the progress in zone Ⅱ stage 3 ROP after initial IVR injection.

摘要： Retinopathy of prematurity(ROP)is a proliferative disorder of the developing retina in premature and low birth weight infants.Recently,the role of vascular endothelial growth factor(VEGF)in the pathophysiology of ROP has been well studied and anti-VEGF drugs have been used in phase 2 to treat ROP patients in many ways.At first,ophthalmologists began to give intravitreal bevacizumab(IVB)or ranibizumab off-label to treat ROP as a salvage treatment after failure in laser photocoagulation or in combination with laser as an adjuvant treatment for patients had media opacity or rigid pupil.Now anti-VEGF drugs are also used as monotherapy in type I ROP or perioperative use in stage 4/5 ROP.Questions remain regarding long-term safety,dose,timing,visual outcomes and long-term effects,including systemically.

摘要： 目的 观察玻璃体内注射Ranibizumab治疗糖尿病性黄斑水肿的短期疗效.方法 在我院诊断为糖尿病性黄斑水肿患者34例(46眼),应用药物治疗、激光治疗或手术治疗,黄斑水肿无改善或持续加重,应用Ranibizumab 0.5 mg(0.05 mL)玻璃体内注射,术后随访12个月,根据眼底、视力及OCT检查决定是否再次注射.结果 所有患者玻璃体内注射Ranibizumab无局部和全身并发症.每眼注射次数为1～4次,平均2.39次,重复注射时间为注射后1.0～1.5个月.46眼注射后12个月视力不同程度提高者44眼,2眼保持不变,注射后7d、1个月、6个月、12个月最佳矫正视力分别提高2.32个、3.47个、5.34个和6.25个字母.OCT检查结果显示注射Ranibizumab后黄斑区视网膜水肿明显减轻,首次注射后7d、1个月、6个月、12个月黄斑中心视网膜厚度值分别为(425±38) μm、(372±41) μm、(294±32) μm和(276±25) μm,与注射前(647±42) μm相比差异均有统计学意义(均为P ＜0.05).结论 对于糖尿病性黄斑水肿患者,玻璃体内注射Ranibizumab具有很好的安全性和有效性,可明显促进黄斑水肿吸收,提高视力,OCT检查可作为评价是否需要再次注射的标准.

摘要： 目的：观察新生血管性青光眼复合式小梁切除术围手术期进行玻璃体内注射雷珠单抗( ranibizumab)对虹膜新生血管及眼压的影响。方法：对2013-01/2014-01收治于安阳市眼科医院药物不能控制的38例38眼新生血管性青光眼患者,行ranibizumab玻璃体内注射+复合式小梁切除术+全视网膜光凝术。术后随访6mo,观察治疗前后虹膜新生血管、眼压及视力变化。结果：玻璃体内注药后7d,36例(94.74％)虹膜新生血管完全消退,2例(5.26％)虹膜细小血管全部消退,残留少许粗大血管。复合式小梁切除术后1mo,所有病例虹膜新生血管均消退；术后3mo,8例(21.05％)虹膜新生血管再次出现,行ranibizumab玻璃体内注射；术后6mo,所有患者均未见虹膜新生血管。注药前平均眼压为42.82±10.29mmHg,注药后5d为39.13±9.71mmHg,注药前后眼压变化无统计学意义(q=2.65,P>0.05)。复合式小梁切除术后1wk,1、3、6mo,眼压分别为10.53±1.81、10.11±1.73、11.29±2.49、12.58±3.01mmHg,与注药前相比有统计学差异( q=23.15、23.46、22.61、21.68,均P0. 05). At 1wk,1,3 and 6mo after compound trabecuIectomy, IOP was 10. 53± 1.81mmHg, 10.11±1.73mmHg, 11.29±2.49mmHg, 12.58± 3. 01mmHg,which decreased significantIy (q=23. 15,23. 46, 22. 61, 21. 68, aII P<0. 01 ) compared with that before injection. Compared with the IOP at 5d after compound trabecuIectomy, the IOP at 1wk,1,3 and 6mo decreased significantIy (q=20. 51,20. 81,19. 96,19. 04, aII P<0. 01) . The success rate of compound trabecuIectomy was 73. 68%. FoIIowed up for 6 mo, visuaI acuity in 24 cases (63. 16%) improved and in 14 cases (36. 84%) remained unchanged. CONCLUSION: IntravitreaI injection of ranibizumab at perioperative period of compound trabecuIectomy can effectiveIy improve the success rate of the surgeries and reduce risk of compIications, and the effect is certainIy safe.