玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉状脉络膜血管病变的临床观察  

Efficacy of combined intravitreal bevacizumab injection and photodynamic therapy for polypoidal choroidal vasculopathy

作　　者：崔丽红[1] 张更华[1] 王治骞 徐丽[1] 

机构地区：[1]沈阳市第四医院眼科,110031

出　　处：《临床眼科杂志》2016年第3期211-214,共4页Journal of Clinical Ophthalmology

摘　　要：目的观察玻璃体腔注射雷珠单抗联合光动力疗法（PDT）治疗息肉状脉络膜血管病变（PCV）的临床疗效和安全性。方法回顾分析临床确诊为PCV的患者19例（19只眼）,所有患者行ETDRS视力表检查、前置镜下眼底检查、荧光素眼底血管造影（FFA）、吲哚菁绿血管造影（ICGA）、相干光断层扫描（OCT）检查。所有患者按照常规内眼手术操作要求玻璃体腔内注射10 mg/ml雷珠单抗0.05 ml,注射后3-7 d联合PDT治疗,随访12个月。以末次随访时间为观察比较点,比较分析治疗前后视力、黄斑中心凹视网膜厚度（CRT）、黄斑出血和渗出情况。结果所有患者均未出现与治疗相关的局部和全身并发症。重复联合治疗1次者6只眼,2次者1只眼,平均联合治疗次数为（1.42±0.6）次。治疗前最佳矫正视力（BCVA）平均（19.95±11.36）个字母,末次随访BCVA平均（31.63±11.75）个字母,较治疗前提高11.68个字母,治疗前后平均视力比较,差异有统计学意义（t=-3.27,P〈0.01）。治疗前患眼平均CRT为（383.67±90.42）μm,治疗后平均CRT为（192.75±42.36）μm,较治疗前下降190.92μm,治疗前后平均CRT比较,差异有统计学意义（t=8.09,P〈0.01）。FFA和ICGA检查13只眼荧光渗漏停止（占68.4%）,6只眼仍有轻度渗漏（占31.6%）。结论玻璃体腔注射雷珠单抗联合PDT治疗PCV是安全有效的,有利于提高患者视力,减轻视网膜水肿,停止或减少息肉病灶的渗漏。Objective To observe the efficacy of combined intravitreal bevacizumab injection and photodynamic therapy（ PDT） in patients with polypoidal choroidal vasculopathy（ PCV）. Methods In this retrospective and comparative study,19 patients（ 19 eyes） with PCV were enrolled. All patients were assessed by examinations including ETDRS visual acuity,preplaced-mirror ophthalmoscopy,fundus fluorescein angiography（ FFA）,indocyanine green angiography（ ICGA） and optical coherence tomography（ OCT）. Patients received intravitreal injected bevacizumab 0. 5mg（ 0. 05ml） first,followed by PDT at the third to seventh day after injection. Treatments were repeated when necessary. The follow-up period was 12 months. Visual acuity,central retinal thickness and leakage of PCV before and after treatment were compared at the end of follow-up. Results No complications occurred in all patients during the treatment or follow-up. Combined treatment was repeated once in 6 patients and twice in 2 patients. Average number of combined therapy was 1. 42 ± 0. 6. Mean best corrected visual acuity improved from 19. 95 ± 11. 36 letters to 31. 63 ± 11. 75 letters after the therapy（ t =- 3. 27,P〈0. 01）. Mean central retinal thickness reduced from 383. 67 ± 90. 42 m to 192. 75 ± 42. 36 m（ t = 8. 09,P〈0.01）. FFA and ICGA showed 13 eyes（ 68. 4%） had no leakage and 6 eyes（ 31. 6%） had mild leakage. Conclusions Intravitreal bevacizumab injection combined with PDT for PCV is safe and effective. This treatment can improve visual acuity,reduce retina edema and leakage of PCV.

关 键 词：息肉状脉络膜血管病变 光化学疗法 单克隆抗体 

分 类 号：R773.4[医药卫生—眼科]