光学相干断层扫描血管成像观察抗血管内皮生长因子治疗渗出性老年性黄斑变性的临床疗效  

Clinical efficacy of anti-VEGF on exudative Senile macular degeneration based on ANGIO-OCT

作　　者：苏强[1] 杨璐[2] 王春芳[1] 王瑞栋[1] Su Qiang;Yang Lu;Wang Chunfang;Wang Ruidong(Department of Ophthalmology,First Hospital of Shanxi Medical University,Taiyuan030001,China)

机构地区：[1]山西医科大学第一医院眼科,太原030001 [2]山西省眼科医院视网膜一科

出　　处：《中国药物与临床》2020年第16期2683-2686,共4页Chinese Remedies & Clinics

基　　金：山西省软科学研究一般项目计划(2018041024-4)。

摘　　要：目的 探讨基于光学相干断层扫描血管成像(ANGIO-OCT)观察抗血管内皮生长因子(VEGF)治疗渗出性老年性黄斑变性的临床疗效.方法 选取我院2016年10月至2019年5月收治的渗出性老年性黄斑变性患者60例(共60只眼),均按照连续3次每月注射后改用按需治疗方案(3+PRN)给予患者雷珠单抗玻璃体腔注射治疗,并采用ANGIO-OCT扫描患者视网膜.比较治疗前后患者ANGIO-OCT图像特征、最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、黄斑区视网膜外层血流密度(ORVD)、脉络膜毛细血管层血流密度(CCVD)的变化情况及不良反应发生情况;采用Pearson法分析BCVA与CRT、ORVD及CCVD的相关性.结果 抗VEGF治疗后,末次随访与治疗前相比,发现患者脉络膜新生血管形态有所好转,趋于正常化,周边毛细血管数量和密度均有所下降.治疗后第1、3、6个月,患者BCVA、CRT均明显低于治疗前(P<0.05),且治疗后第3个月患者BCVA、CRT均明显低于第1、6个月(P<0.05).治疗后第1、3、6个月,患者ORVD、CCVD均明显高于治疗前(P<0.05),且治疗后第3个月患者ORVD、CCVD均明显高于第1、6个月(P<0.05).治疗后,7例患者出现眼内异物感,2例患者出现一过性眼压升高,3例患者出现球结膜下出血,休息后症状自行好转,不良反应的总发生率为20%.BCVA与CRT呈正相关(P<0.05),与ORVD及CCVD呈负相关(P<0.05).结论 抗VEGF药物对渗出性老年性黄斑变性具有良好的治疗效果,可显著改善患者视力,且安全性较高. ANGIO-OCT可为患者的治疗与随访提供指导.Objective To nvestigate the clinical efficacy of anti-vascular endothelial growth factor(VEGF)in the treatment of exudative Senile macular degeneration based on optical coherence tomography angiography(ANGIO-OCT).Methods A total of 60 patients(60 eyes)with exudative Senile macular degeneration admitted to our hospital between October 2016 and May 2019 were included in the study.According to 3+PRN protocol,all patients were given intravitreal injection of ranibizumab,and their retinas were scanned with ANGIO-OCT.The changes of ANGIO-OCT image characteristics,best corrected visual acuity(BCVA),macular central retinal thickness(CRT),outer retinal vessel density(ORVD)at the macular area and choroidal capillary vessel density(CCVD)and the occurrence of adverse reactions at baseline and after the treatment were compared.Pearson method was used to determine the correlation of BCVA with CRT,ORVD and CCVD.Results After anti-VEGF treatment,the last follow-up was compared with that at baseline.It showed that the morphology of the choroidal neovascularization in the patients improved,tending to normalize,and the number and density of peripheral capillaries decreased.At 1,3,and 6 months after the treatment,the BCVA and CRT were significantly lower than those at baseline(both P<0.05).The BCVA and CRT at 3 months after the treatment were significantly lower than those at 1 and 6 months after the treatment(both P<0.05).At 1,3,and 6 months after the treatment,the ORVD and CCVD were significantly higher than those at baseline(both P<0.05).The ORVD and CCVD at 3 months after the treatment were significantly higher than those at 1 and 6 months after the treatment(both P<0.05).After the treatment,there were 7 cases of intraocular foreign body sensation,2 of temporary high intraocular pressure,and 3 of subconjunctival hemorrhage.All the symptoms re-lieved spontaneously after rest.The total incidence of adverse reactions was 20%.BCVA was posi-tively correlated with CRT(P<0.05),and negatively correlated with ORVD and CCVD(P<0.05).Conclu

关 键 词：体层摄影术 光学相干 血管内皮生长因子类 黄斑变性 雷珠单抗 治疗结果 

分 类 号：R774.5[医药卫生—眼科]