玻璃体腔内注射Bevacizumab联合眼底激光治疗视网膜静脉阻塞继发黄斑水肿的临床观察  

Clinical observation of intravitreal Bevacizumab combined with laser photocoagulation for treatment of macular edema secondary to retinal vein occlusion

作　　者：王雯秋[1] 王泓[1] 姜媛[1] 王卫峻[1] 张磊[1] 钱锦[1] 汪枫桦[1] 吴颖[1] 孙晓东[1] 

机构地区：[1]上海交通大学附属第一人民医院眼科,200080

出　　处：《中华眼视光学与视觉科学杂志》2012年第2期90-94,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：上海市视觉复明临床医学中心基金资助项目（FM040102）;上海市启明星追踪计划资助项目（08QH14016）

摘　　要：目的观察玻璃体腔内注射Bevacizumab联合眼底激光治疗视网膜静脉阻塞（RVO）继发黄斑水肿的安全性及临床疗效。方法回顾性系列病例研究。确诊的RVO继发黄斑水肿患者共30例（30眼），其中分支静脉阻塞20例，中央静脉阻塞10例。年龄34—79岁，平均（57．3＋8．9）岁。玻璃体腔内注射Bevacizumab的剂量按照PrONTO研究组方法，为1．25mg，3次注射后，根据眼底荧光造影（FFA）结果补充眼底激光治疗。治疗前和治疗后1、3、6、12个月对患者进行视力、眼底照相、相干光学断层扫描、FFA检查。采用ETDRS视力表进行视力检查；采用光学相关断层扫描仪测量黄斑区视网膜神经上皮层厚度（CRT）。患者治疗后各个时间点的最佳矫正视力（BCVA）、CRT值与治疗前基线值比较采用配对t检验，RVO患者各个时间点的BCVA与CRT值的相关性采用直线回归分析。结果30例RVO患者平均接受玻璃体腔内注射（3．9±1．9）次，视力提高15个字符及以上者16眼（54％），视力提高5。lO个字符者10眼（33％），视力稳定在5个字符以内者4眼（13％）。治疗后12个月时，ETDRS视力为60±19，与治疗前（42±19）相比，差异有统计学意义（f=7．87，P〈O．05）。平均CRT值末次随访时为（268．9±115．9）μm，与治疗前［（616．7±177．0）μm]相比，差异有统计学意义（t=13．23，P〈O．01）。治疗后12个月BCVA与治疗前BCVA的相关性存在统计学意义（r=0．791，P〈0．01），无论何种类型静脉阻塞，基线视力、预后视力与治疗前黄斑水肿程度均无相关性。末次随访时21眼（70％）黄斑区未见明显囊性积液，9眼（30％）仍有少量囊性积液，FFA显示复发的主要原因为黄斑区小血管渗漏。治疗及随访过程中未见明显不良反应发生。结论对RVO继发黄斑水肿患者进行玻璃体腔内注射Bevacizumab联合眼底激光治疗，可保存或改善�Objective To evaluate the efficacy and safety of intravitreal injection of Bevaeizumab （Avastin） combined with laser photocoagulation in the patients of macular edema secondary to retinal vein occlusion （RVO）. Methods This was a retrospective cases-series study. Thirty eyes of 30 RVO patients （branch RVO 20 eyes and central RVO 10 eyes） were erolled, aged from 34 to 79, with average of （57.3±8.9）years. The eyes were treated with intravitreal injections of Bevacizumab （1.25 mg） combined with laser photoeoagulation. The treatment method of intravitreal injection had been conducted according to PRONTO study. Best corrected visual acuity （BCVA, ETDRS letters）, fundus photography, optical coherence tomography （OCT） were committed at baseline and 1, 3, 6, 12 months after intravitreal injection. The ETDRS letters and the central retinal thickness （CRT） by OCT were recorded. Changes in BCVA and CRT measurements from baseline at the various follow-up endpoints were assessed with paired t test. Spearman correlation coefficient was used to measure the strength of correlation between BCVA and anatomic changes. Results The mean number of the injections in the 30 patients was 3.9±1.9. The BCVA improved 3 or more lines in 16 eyes （54%）, improved 1 to 2 lines in 10 eyes （33%）, stabilized （±1 line or no change） in 4 eyes （13%） and none decreased. The average BCVA at baseline was （42±19） letters, and improved to （60±19） letters at 12 months （t=7.87, P〈O.05）. The average of retinal thickness of macular foveal decreased from （616.7-＋177.0）μm at baseline to （268.9-＋l15.9）μm at 12 months （t=13.23, P〈0.05）. BCVA 12 months post-treatment was correlated to BCVA pre-treatment （r=0.791, P〈0.01）. Macular edema had no correlation with baseline and finally BCVA. 21 eyes （70%） showed no observed macular edema by the last follow-up and the side effects were not observed during the follow-up. Conclusion The persistent and rebound macular edema found

关 键 词：视网膜静脉闭塞 黄斑水肿 血管内皮生长因子A 贝伐单抗 激光疗法 

分 类 号：R779.6[医药卫生—眼科]