玻璃体内注射雷珠单抗联合激光光凝治疗Coats病的疗效观察  

Intravitreal lucentis injections combined with laser photocoagulation for Coats disease

作　　者：毛新帮[1] 游志鹏[1] 彭灵[1] 吴琛[1] 黄俊[1] 胡筱琴 徐琰瑛 MAO Xin-Bang YOU Zhi-Peng PENG Ling WU Chen HUANG Jun HU Xiao-Qin XU Yan-Ying

机构地区：[1]南昌大学第二附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2017年第3期259-262,共4页Recent Advances in Ophthalmology

摘　　要：目的观察玻璃体内注射雷珠单抗联合激光光凝治疗Coats病的效果。方法选择自2012年8月至2015年12月经眼底荧光血管造影及光学相干断层扫描诊断为Coats病的患者18例(18眼)为研究对象,所有患者先接受玻璃体内注射雷珠单抗,1周后在眼底荧光血管造影引导下行视网膜激光光凝术,必要时进行重复治疗。术后对最佳矫正视力及黄斑中心凹视网膜厚度(central macular thickness,CMT)进行观察,随访时间为16~24个月,平均18.8个月。结果雷珠单抗的平均注射次数为2.6次,激光光凝次数为1.8次。术前最佳矫正视力为(0.81±0.28)LogMAR,末次随访时最佳矫正视力为(0.76±0.37)LogMAR(P=0.396)。视力提高大于0.3 LogMAR者3例(16.7%),视力改变在0.3 LogMAR以内者13例(72.2%),视力下降大于0.3 LogMAR者2例(11.1%)。术前CMT为(341.11±67.97)μm,末次随访时为(277.83±51.59)μm(P=0.030)。末次随访时最佳矫正视力与术前最佳矫正视力显著相关(r=0.817,P<0.001)。伴有黄斑中心凹下硬性渗出的患眼末次随访时最佳矫力较不伴有硬性渗出者差(P=0.044)。结论玻璃体内注射雷珠单抗联合激光光凝是治疗Coats病的有效方法,可以稳定视力,降低CMT。术后视力与术前视力及黄斑中心凹下硬性渗出有关。Objective To observe the therapeutic effect of intravitreal lucentis injections combined with laser photocoagulation for Coats disease.Methods This was a retrospective case series study.From August 2012 to December 2015,18 cases （18 eyes） were diagnosed as Coats disease with macular edema by FFA and OCT.All patients were treated at baseline using intravitreal lucentis injections.One week later,photocoagulation was performed by the guiding of FFA.Follow-up treatment was performed as necessary.The primary BCVA and central macular thickness （CMT） was measured postoperatively.The follow-up time was 16-24 months （mean 18.8 months）.Results The mean number of lucentis injections was 2.6,and the mean number of laser treatment sessions was 1.8.The mean preoperative BCVA was （0.81±0.28） LogMAR,while the final visit was （0.76±0.37） LogMAR（P=0.396）.In 3 patients （16.7 %）,BCVA had improved by more than 3 lines,and 13 patients （72.2%） showed stable BCVA （changes within 2 lines of visual acuity）,while in 2 patients,BCVA decreased by more than 3 lines （11.1%）.The mean CMT improved significantly from （341.11±67.97） μm preoperatively to （277.83±51.59） μm at the final visit （P=0.030）.Final BCVA was significantly correlated with preoperative BCVA （r=0.817,P〈0.001）.The final BCVA of patients with subfoveal hard exudates preoperatively was significantly worse than that of patients without such exudates （P=0.044）.Conclusion Intravitreal lucentis injection combined with laser photocoagulation may be an effective treatment for Coats disease.It may stablize the visual acuity,decrease the CMT of Coats disease.The final BCVA is associated with preoperative BCVA and occurrence of subfoveal hard exudates.

关 键 词：雷珠单抗 玻璃体内注射 激光光凝 COATS病 

分 类 号：R774.1[医药卫生—眼科]