视网膜下注射和玻璃体腔注射康柏西普治疗息肉样脉络膜血管病变的疗效分析  

Analysis of the efficacy of subretinal injection and intravitreal injection of conbercept in the treatment of polypoidal choroidal vasculopathy

作　　者：刘腾[1] 余晓 吴晓坚 邹玉凌[1] 刘康成 邹华 吴伟[1] 许诚豪 游志鹏[1] Liu Teng;Yu Xiao;Wu Xiaojian;Zou Yuling;Liu Kangcheng;Zou Hua;Wu Wei;Xu Chenghao;You Zhipeng(Affiliated Eye Hospital of Nanchang University,Eye Hospital of Jiangxi Province,Nanchang 330006,China)

机构地区：[1]南昌大学附属眼科医院江西省眼科医院,南昌330006

出　　处：《中华眼底病杂志》2024年第6期421-428,共8页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(82260212);中央引导地方科技发展基金(2022ZDG02012);江西省科技厅重点研发计划-重点项目(揭榜挂帅)(20223BBH80W01);江西省卫健委科技创新重点项目(2023ZD004);江西省自然科学基金重点项目(20232ACB206029);江西省教育厅重点项目(GJJ210126);江西省卫生健康委科技计划项目(202410040)。

摘　　要：目的对比观察视网膜下注射和玻璃体腔注射康柏西普治疗息肉样脉络膜血管病变(PCV)的临床疗效。方法前瞻性随机双盲对照研究。2022年6月至2023年1月于南昌大学附属眼科医院检查确诊的PCV患者35例35只眼纳入研究。所有患者均为首次接受治疗者。患眼均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)、吲哚青绿血管造影(ICGA)检查。采用国际标准视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪的增强深度成像技术测量患眼中心凹视网膜厚度(MRT)、中心凹下脉络膜厚度(SFCT)、色素上皮脱离(PED)高度。采用随机数字表法将患者分为视网膜下注药组(A组)、玻璃体腔注药组(B组),分别为18例18只眼,17例17只眼。两组患者年龄(t=0.090)、病程(t=−0.370)、logMAR BCVA(t=−0.190)、MRT(t=0.860)、SFCT(t=0.247)、PED高度(t=−0.520)比较,差异均无统计学意义(P>0.05)。A组患眼均给予1次视网膜下注射10 mg/ml的康柏西普0.05 ml(含康柏西普0.5 mg)治疗,其后按需给药(PRN);B组患眼玻璃体腔注射10 mg/ml的康柏西普0.05 ml(含康柏西普0.5 mg),治疗方案为3+PRN。根据治疗后OCT、BCVA检测结果将病变分为活动型及静止型。活动型病变给予玻璃体腔注射康柏西普治疗,剂量同前;静止型病变,随访观察。治疗后1、2、3、6、9个月行BCVA、OCT检查;治疗后3、6、9个月同时行ICGA检查。对比观察两组患眼治疗前后BCVA、MRT、SFCT、PED高度的变化情况。两组间比较采用独立样本t检验。结果随治疗后时间延长,A组、B组患眼BCVA逐渐提高,MRT、SFCT、PED高度逐渐降低。与B组比较,治疗后2、3、6、9个月,A组BCVA显著提高,差异有统计学意义(t=−2.215、−2.820、−2.559、−4.051,P<0.05);治疗后1、2、3、6、9个月,A组患眼MRT(t=−2.439、−3.091、−3.099、−3.665、−5.494)、SFCT(t=−3.370、−3.058、−3.268、−4.220、−4.121)、PED高度(t=−3.4Objective To observe the clinical effect of subretinal injection and intravitreal injection of conbercept in the treatment of polypoid choroidal vasculopathy(PCV).Methods A prospective,randomized double-blind controlled study.From June 2022 to January 2023,35 patients of 35 eyes with PCV diagnosed at Affiliated Eye Hospital of Nanchang University were included in the study.All patients were first-time recipients of treatment.Best corrected visual acuity(BCVA),optical coherence tomography(OCT),and indocyanine green angiography(ICGA)were performed in all affected eyes.BCVA was performed using an international standard visual acuity chart and converted to logarithmic minimum resolved angle(logMAR)visual acuity for statistical purposes.Enhanced depth imaging with OCT instrument was used to measure the macular retinal thickness(MRT),subfoveal choroidal thickness(SFCT),and pigment epithelium detachment(PED)height.Randomized numerical table method was used to divide the patients into subretinal injection group(group A)and vitreous cavity injection group(Group B),18 cases with 18 eyes and 17 cases with 17 eyes,respectively.Comparison of age(t=0.090),disease duration(t=−0.370),logMAR BCVA(t=−0.190),MRT(t=0.860),SFCT(t=0.247),and PED height(t=−0.520)between the two groups showed no statistically significant difference(P>0.05).The eyes of group A were given one subretinal injection of 10 mg/ml conbercept 0.05 ml(containing conbercept 0.5 mg),and subsequently administered on demand(PRN);eyes in group B were given intravitreal injection of 10 mg/ml conbercept 0.05 ml(containing conbercept 0.5 mg).The treatment regimen was 3+PRN.Lesions were categorized into active and quiescent according to the results of post-treatment OCT and BCVA.Active lesions were treated with intravitreal injection of conbercept at the same dose as before;stationary lesions were followed up for observation.BCVA and OCT were performed at 1,2,3,6 and 9 months after treatment;ICGA was performed at 3,6 and 9 months.BCVA,MRT,SFCT,and PED height changes

关 键 词：息肉样脉络膜血管病变 视网膜下注射 玻璃体腔注射 康柏西普 

分 类 号：R773.4[医药卫生—眼科]