玻璃体内注射雷珠单抗治疗病理性近视继发脉络膜新生血管  

Efficacy of intravitreal ranibizumab for the treatment of choroidal neovascularization secondary to pathological myopia

作　　者：孙早荷 万光明[1] 钱诚[1] 梁申芝[1] 王炯[1] SUN Zao-He;WAN Guang-Ming;QIAN Cheng;LIANG Shen-Zhi;WANG Jiong(From the Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2018年第10期925-929,共5页Recent Advances in Ophthalmology

摘　　要：目的对比观察玻璃体内注射雷珠单抗的两种方案治疗病理性近视(pathological myopia,PM)继发脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效。方法收集2016年1月至2017年6月在我院接受治疗的PM-CNV患者49例(49眼)纳入本研究。所有患眼均行玻璃体内注射雷珠单抗(0. 05 m L,含雷珠单抗0. 5 mg)治疗。依据接受治疗情况将患者分为1+PRN组(注射一次后再按需注射) 25例25眼、3+PRN组(连续注射3个月后再按需注射) 24例24眼。随访时间为12个月。比较治疗后两组患眼的平均治疗次数、最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹视网膜厚度(central macular thickness,CMT)以及CNV渗漏变化情况。结果 1+PRN组、3+PRN组患眼治疗次数分别为(1. 92±1. 12)次、(3. 21±0. 42)次,差异有统计学意义(Z=-4. 056,P=0. 000)。治疗后6个月、12个月,1+PRN组患眼BCVA分别为(0. 57±0. 28)log MAR、(0. 50±0. 26) log MAR,3+PRN组患眼BCVA分别为(0. 58±0. 22) log MAR、(0. 51±0. 25) log MAR,两组治疗后同一时间点BCVA比较,差异均无统计学意义(t=-0. 214、-0. 172,P=0. 831、0. 864)。治疗后6个月、12个月,1+PRN组患眼CMT值分别为(285. 16±66. 08)μm、(247. 40±55. 10)μm,3+PRN组患眼CMT值分别为(286. 29±29. 53)μm、(241. 04±35. 39)μm,两组治疗后同一时间点CMT比较,差异均无统计学意义(t’=-0. 080、-0. 480,P=0. 938、0. 632)。治疗后12个月,1+PRN组、3+PRN组治疗总有效率分别为84%、92%,两组患眼CNV渗漏治疗总有效率的比较,差异无统计学意义(χ~2=0. 146,P=0. 702)。结论 1+PRN方案在保证疗效的前提下减少了注药次数,提示1+PRN方案更适合于PM-CNV的治疗。Objective To compare the clinical efficacy of two different intravitreal ranibizumab injection regimens in patients with choroidal neovascularization(CNV)secondary to pathological myopia(PM).Methods Forty-nine eyes of 49 patients with PM-CNV in our hospital from January 2016 to June 2017 were enrolled into this study.All patients were treated with intravitreal injection of 0.05 mL ranibizumab(10 g·L-1).The patients were divided into two groups:1+PRN group including 25 patients(25 eyes)treated with a single intravitreal injection and 3+PRN group including 24 patients(24 eyes)treated with three consecutive monthly intravitreal injections.The follow-up period was 12 months.The mean times of injection,best corrected visual acuity(BCVA),central macular thickness(CMT)and leakage of CNV after treatment were compared.Results The mean times of injection in the 1+PRN group and 3+PRN group were 1.92±1.12 and 3.21±0.42 respectively,and the difference between the two groups was statistically significant(Z=-4.056,P=0.000).At 6 months and 12 months after treatment,the BCVA was(0.57±0.28)logMAR and(0.50±0.26)logMAR in the 1+PRN group,and(0.58±0.22)logMAR and(0.51±0.25)logMAR in the 3+PRN group,respectively.There were no significant difference in BCVA between the two groups at each time point(t=-0.214,-0.172 and P=0.831,0.864,respectively).The CMT values were(285.16±66.08)μm and(247.40±55.10)μm in the 1+PRN group,and(286.29±29.53)μm and(241.04±35.39)μm in the 3+PRN group at 6 months and 12 months after treatment,respectively.There were no statistical difference in CMT values of the two groups at the both time points(t’=-0.080,-0.480 and P=0.938,0.632,respectively).The overall rates of efficacy of CNV leakage were 84%and 92%in the 1+PRN group and 3+PRN group,respectively.At 12 months after treatment,the difference was not statistically significant(χ2=0.146,P=0.702).Conclusion The 1+PRN regimen decreases the times of total injections for guaranteeing the efficacy,suggesting it is a more suitable therapy to PM-CNV.

关 键 词：脉络膜新生血管 病理性近视 雷珠单抗 

分 类 号：R778.1[医药卫生—眼科]