阿柏西普初始治疗及换药治疗对渗出型老年性黄斑变性的短期疗效观察  

Short-term efficacy of primary treatment and dressing change with aflibercept for exudative age-related macular degeneration

作　　者：邓凯予 叶娅 黄晓莉 黄珍 韩昀 闫明 陈晓 宋艳萍 Deng Kaiyu;YeYa;Huang Xiaoli;Huang Zhen;HanYun;Yan Ming;Chen Xiao;Song Yanping(Department of Ophthalmology,Central Theater Command Hospital of People’s Liberation Army,Wuhan 430070,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510000,China)

机构地区：[1]解放军中部战区总医院眼科,武汉430070 [2]南方医科大学第一临床医学院,广州510000

出　　处：《中华眼底病杂志》2021年第9期687-692,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察玻璃体腔注射阿柏西普(IVA)初始治疗及换药治疗对渗出型老年性黄斑变性(eAMD)的短期疗效。方法回顾性临床研究。2018年6月至2021年2月于解放军中部战区总医院眼科行IVA治疗的eAMD患者38例49只眼纳入研究。其中,男性24例29只眼,女性14例20只眼;平均年龄(66.82±8.71)岁。所有患眼均行IVA治疗。起始负荷剂量2.0 mg,每月注射1次,连续3个月,随后每月复查并评估按需治疗。49只眼中,26只眼为初始治疗(初治组),即首次发病3个月内确诊并行IVA治疗,且从发病到初诊未进行眼内药物及手术治疗;23只眼为换药治疗(换药组),其换用阿柏西普治疗前6个月接受玻璃体腔注射雷珠单抗和(或)康柏西普治疗≥4次,期间存在持续性黄斑区视网膜层间囊样水肿和(或)视网膜下积液(SRF)、无改善的色素上皮脱离(PED)。IVA治疗前两组患眼最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、PED高度(PEDH)、PED体积(PEDV)比较,差异均无统计学意义(P>0.05)。治疗后1、3、6个月采用与治疗前相同的设备和方法行相关检查,记录两组患眼BCVA、CMT、PEDH、PEDV变化及并发症发生情况。两组间的BCVA、CMT、PEDH、PEDV比较采用重复测量方差分析。结果治疗后6个月,初治组、换药组患眼IVA注射次数分别为(4.15±0.73)、(4.39±0.72)次,差异无统计学意义(t=-1.141,P=0.260)。初治组(F=5.345、22.995、6.764、5.425)、换药组(F=12.519、15.576、8.843、9.406)患眼治疗后1、3、6个月BCVA、CMT、PEDH、PEDV均较治疗前明显改善,差异均有统计学意义(P<0.05)。初治组与换药组患眼治疗后各时间点BCVA、CMT、PEDH、PEDV比较,差异均无统计学意义(F=1.741、0.069、0.876、3.455,P>0.05)。随访期间所有患眼均未出现持续性眼压升高、眼内炎、视网膜色素上皮撕裂等并发症的发生。结论 IVA治疗eAMD可提高患眼视力,降低CMT、PEDH、PEDV;初始治疗与换药治疗疗效相当。Objective To observe the short-term effects of intravitreal injection of aflibercept(IVA)for initial treatment and dressing change on exudative age-related macular degeneration(eAMD).Methods A retrospective clinical study.From June 2018 to February 2021,forty-nine eAMD eyes of 38 patients who underwent IVA treatment in Department of Ophthalmology of Central Theater Command Hospital of People's Liberation Army were included in the study.Among them,there were 24 males with 29 eyes and 14 females with 20 eyes;the average age was 66.82±8.71 years.All affected eyes were treated with IVA.The initial loading dose was 2.0 mg,which was injected once a month for 3 consecutive months,followed by monthly review and treatment as needed.Of the 49 eyes,26 eyes were initially treated(initial treatment group),they were diagnosed within 3 months of the first onset and followed by IVA treatment,and no intraocular drugs and surgery were performed from the onset to the first diagnosis.Twenty-three eyes were treated with drug exchange therapy(dressing change group),they received intravitreal injection of ranibizumab and/or conbercept more than 4 times 6 months before the replacement therapy,during which there was persistent interlaminar cystoid edema and/or subretinal fluid(SRF)in the macular area and no improvement in pigment epithelial detachment(PED).Before IVA treatment,there were no statistically significant differences in the best corrected visual acuity(BCVA),foveal thickness(CMT),PED height(PEDH),and PED volume(PEDV)of the two groups of eyes before IVA treatment(P>0.05).The same equipment and methods as before treatment were used for related examinations,and the changes of BCVA,CMT,PEDH,PEDV and complications of the two groups of eyes were recorded in 1,3,and 6 months after treatment.The comparison of BCVA,CMT,PEDH,and PEDV between the two groups were used repeated measures analysis of variance.Results Six months after treatment,the number of IVA injections in the eyes of the initial treatment group and dressing change group

关 键 词：湿性黄斑变性 重组融合蛋白质类 血管生成抑制剂 

分 类 号：R774.5[医药卫生—眼科]