玻璃体腔注射抗血管内皮生长因子药物治疗Coats病的前瞻性病例对照研究  

A prospective case-control study of intravitreal injection of anti-vascular endothelial factor drugs in the treatment of Coats disease

作　　者：阮露 居钰乔 张娟 江晨 杨茜 黄欣 Ruan Lu;Ju Yuqiao;Zhang Juan;Jiang Chen;Yang Qian;Huang Xin(Department of Ophthalmology,Eye and ENT Hospital,Shanghai Medical College,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2022年第7期556-561,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(82070975);上海市科协技术委员会扬帆计划(21YF1405200)。

摘　　要：目的观察传统激光光凝(以下简称为激光)、激光联合玻璃体腔注射抗血管内皮生长因子(VEGF)药物、单纯玻璃体腔注射抗VEGF药物治疗Coats病的疗效及安全性。方法前瞻性病例对照研究。2016年12月至2019年11月于复旦大学附属眼耳鼻喉科医院眼科连续就诊且未经治疗的Coats病2B~3A2期患者60例60只眼纳入研究。根据治疗方式将患者分为激光组、联合组、注药组。激光组患眼初始治疗为单纯传统激光治疗;注药组患眼初始治疗为单纯玻璃体腔注射抗VEGF药物,每一个月1次,连续3个月;联合组患眼初始治疗为激光联合玻璃体腔注射抗VEGF药物,或抗VEGF药物治疗后1周内行激光治疗。随访时间>6个月,随访时均行最佳矫正视力(BCVA)、超广角眼底照相、荧光素眼底血管造影检查。对比观察3组间的治疗有效率、视网膜下液(SRF)、黄斑水肿、BCVA及并发症发生情况。结果60例60只眼中,男性55例,女性5例;年龄(17.1±2.0)岁;均为单眼。2B、3A1、3A2期分别为26、23、11只眼。激光组、联合组、注药组各20例20只眼。注药组所有患眼初始治疗后,异常血管均无明显消退;SRF吸收、增加分别为4(20.0%,4/20)、5(25.0%,5/20)只眼。给予补充激光治疗16只眼,玻璃体切割手术(PPV)4只眼。激光治疗的16只眼中,治疗有效10只眼(50.0%,10/20);治疗过程中发生玻璃体积血、纤维膜增生、并发性白内障分别为1、1、2只眼,均再给予PPV治疗;黄斑水肿反复、持续存在分别为4、1只眼。联合组患眼中,治疗有效11只眼(55.0%,11/20);治疗过程中出现SRF增多、纤维膜增生、并发性白内障分别为5、2、2只眼,均再次给予PPV治疗;黄斑水肿反复、持续存在各1只眼。激光组患眼中,治疗有效15只眼(75.0%,15/20);治疗过程中出现大量玻璃体积血、纤维膜增生、并发性白内障分别为2、2、1只眼,均再次给予PPV治疗。结论单纯抗VEGF药物治疗Coats病无效,�Objective To investigate the efficacy and safety of traditional laser photocoagulation,laser combined with intravitreal injection of anti-vascular endothelial factor(anti-VEGF)drugs and intravitreal injection of anti-VEGF drugs alone in Coats disease.Methods The patients diagnosed as Coats disease stage 2B-3A2 in Department of Ophthalmology,Eye and ENT Hospital of Shanghai Medical College of Fudan University from December 2016 to November 2019 were included in this study.Patients were divided into three groups,including laser group,combined group and drug group,according to the different treatment.In the laser group,the initial treatment was traditional laser photocoagulation alone.In the drug group,the anti-VEGF drug was injected into vitreous once a month for three months.The initial treatment of the eyes in the combined group was laser combined with intravitreal injection of anti-VEGF drugs,or laser treatment within 1 week after anti-VEGF drug treatment.The follow-up time was more than 6 months,and best-corrected visual acuity(BCVA),ultra-wide-angle fundus photography,and fluorescein fundus angiography were performed during follow-up.The treatment efficiency,subretinal fluid(SRF),macular edema,BCVA and complications were compared among the three groups.Results Among 60 patients(60 eyes),there were 55 males(55 eyes)and 5 females(5 eyes),with the mean age of 17.1±2.0 years.Among 60 eyes,there were 26 eyes in 2B stage,23 eyes in 3A1 stage,and 11 eyes in 3A2 stage.Twenty patients(20 eyes)was in the laser group,combined group and drug group,respectively.After the initial treatment of all eyes in the drug group,the abnormal blood vessels did not regress significantly;the absorption and increase of SRF were 4(20.0%,4/20)and 5(25.0%,5/20)eyes,respectively.Supplementary laser therapy was given to 16 eyes,and vitrectomy(PPV)was given to 4 eyes.Among the 16 eyes treated by laser,10 eyes were effective(50.0%,10/20);vitreous hemorrhage,fibrous membrane hyperplasia,and complicated cataract occurred in 1,1,and 2 eyes during

关 键 词：视网膜毛细血管扩张症 血管生成抑制剂 激光凝固术 视网膜下液 黄斑水肿 

分 类 号：R774.1[医药卫生—眼科]