玻璃体腔注射抗血管内皮生长因子药物治疗年龄相关性黄斑变性引起的视网膜色素上皮撕裂的特点分析  

Analysis of the characteristics of a retinal pigment epithelium tear after injection of intravitreal anti-vascular endothelial growth factor for the treatment of age-related macular degeneration

作　　者：王静波[1] 关娟[1] 周历[1] 盛豫[1] 司艳芳[1] 

机构地区：[1]解放军第309医院眼科,北京100091

出　　处：《中华眼视光学与视觉科学杂志》2010年第5期378-381,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 总结分析玻璃体腔注射抗血管内皮生长因子（VEGF）药物治疗年龄相关性黄斑变性（AMD）引起的视网膜色素上皮（RPE）撕裂的临床特点.方法 文献分析.通过PubMed和中国生物医学文献光盘数据库检索系统查阅玻璃体腔注射抗VEGF药物治疗AMD引起RPE撕裂的相关文献,统计分析患者的年龄、视力、RPE撕裂的发生率及发生部位、发生RPE撕裂前玻璃体腔注药的次数及周期、玻璃体腔注射的药物种类、撕裂发生的危险因素等.结果 最终有35篇文献（7879眼）纳入研究.发生RPE撕裂的患者的平均年龄为78.6岁（59～96岁）,平均玻璃体腔注药1.6次（1～次）,撕裂发生后至初次诊断的平均时间间隔为34.8 d（1 d～4个月）.玻璃体腔注射任何抗VEGF药物均可能会引起RPE的撕裂,RPE撕裂基本都发生在平行于色素上皮脱离（PED）的边缘.玻璃体腔注药引起RPE撕裂的发生率为0.1%～7.5%,平均1.9%.初次确诊为RPE撕裂时,与撕裂发生前相比,绝大多数患者的视力有提高或保持稳定（81.4%）.经过平均94.9 d的随访,绝大多数患者的最终视力保持稳定或有提高（83.3%）.大范围的血管性PED是RPE撕裂发生的危险因素,当血管性PED的高度＞400μm时,玻璃体腔注药后发生RPE撕裂的危险性明显增加.结论 玻璃体腔注射抗VEGF药物治疗AMD可能会引起RPE的撕裂,但发生率较低,且RPE撕裂对大多数患者的视力无明显影响.大范围的、高的血管性PED是RPE撕裂发生的危险因素.Objective To analyze the characteristics of retinal pigment epithelium （RPE） tears following the injection of intravitreal anti-vascular endothelial growth factor （VEGF） for the treatment of age-related macular degeneration （AMD）. Methods A comprehensive literature review of RPE tears following anti-VEGF therapy for AMD was conducted using the PubMed and CBM disc databases, and the features of RPE tears were summarized. Results A total of 35 studies from the literature were included. The average age of patients who developed RPE tears was 78.6 years （range 59-96 years）, and the average injection times before tears developed was 1.6 （range 1-4）. The mean duration time between the first injection and diagnosis was 34.8 d （range 1 d-4 months）. Despite the development of RPE tears, anti-VEGF therapy can still inhibit choroidal neovascularization. Compared to visual acuity before injection, most patients had better or stable visual acuity （81.4%） even with the development of RPE tears. With an average follow-up of 94.9 days, most patients had stable or better visual acuity （83.3%）. Conclusion Although anti-VEGF therapy for AMD may induce RPE tearing, this complication does not predominantly affect vision. Large-size pigment epithelial detachment （PED） is a risk factor for RPE tears, especially with large or high vascular PED.

关 键 词：血管内皮生长因子 玻璃体腔注药 黄斑变性 年龄相关性 色素上皮 眼 撕裂 

分 类 号：R774.5[医药卫生—眼科]