中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2012年
2期
90-94
,共5页
王雯秋%王泓%姜媛%王卫峻%张磊%钱锦%汪枫桦%吴颖%孙晓东
王雯鞦%王泓%薑媛%王衛峻%張磊%錢錦%汪楓樺%吳穎%孫曉東
왕문추%왕홍%강원%왕위준%장뢰%전금%왕풍화%오영%손효동
视网膜静脉闭塞%黄斑水肿%血管内皮生长因子A%贝伐单抗%激光疗法
視網膜靜脈閉塞%黃斑水腫%血管內皮生長因子A%貝伐單抗%激光療法
시망막정맥폐새%황반수종%혈관내피생장인자A%패벌단항%격광요법
Retinal vein occlusion%Macular edema%Vascular endothelial growth factor A%Bavacizumb%Laser therapy
目的 观察玻璃体腔内注射Bevacizumab联合眼底激光治疗视网膜静脉阻塞(RVO)继发黄斑水肿的安全性及临床疗效.方法 回顾性系列病例研究.确诊的RVO继发黄斑水肿患者共30例(30眼),其中分支静脉阻塞20例,中央静脉阻塞10例.年龄34～79岁,平均(57.3±8.9)岁.玻璃体腔内注射Bevacizumab的剂量按照PrONTO研究组方法,为1.25 mg,3次注射后,根据眼底荧光造影(FFA)结果补充眼底激光治疗.治疗前和治疗后1、3、6、12个月对患者进行视力、眼底照相、相干光学断层扫描、FFA检查.采用ETDRS视力表进行视力检查;采用光学相关断层扫描仪测量黄斑区视网膜神经上皮层厚度(CRT).患者治疗后各个时间点的最佳矫正视力(BCVA)、CRT值与治疗前基线值比较采用配对t检验,RVO患者各个时间点的BCVA与CRT值的相关性采用直线回归分析.结果 30例RVO患者平均接受玻璃体腔内注射(3.9±1.9)次,视力提高15个字符及以上者16眼(54％),视力提高5～10个字符者10眼(33％),视力稳定在5个字符以内者4眼(13％).治疗后12个月时,ETDRS视力为60±19,与治疗前(42±19)相比,差异有统计学意义(t=7.87,P＜0.05).平均CRT值末次随访时为(268.9±115.9) μm,与治疗前[(616.7±177.0)μm]相比,差异有统计学意义(t=13.23,P＜0.01).治疗后12个月BCVA与治疗前BCVA的相关性存在统计学意义(r=0.791,P＜0.01),无论何种类型静脉阻塞,基线视力、预后视力与治疗前黄斑水肿程度均无相关性.末次随访时21眼(70％)黄斑区未见明显囊性积液,9眼(30％)仍有少量囊性积液,FFA显示复发的主要原因为黄斑区小血管渗漏.治疗及随访过程中未见明显不良反应发生.结论 对RVO继发黄斑水肿患者进行玻璃体腔内注射Bevacizumab联合眼底激光治疗,可保存或改善视力,有效减轻黄斑水肿;黄斑区毛细血管渗漏是引起黄斑水肿复发的主要原因,所以重复玻璃体腔注射是必需的.
目的 觀察玻璃體腔內註射Bevacizumab聯閤眼底激光治療視網膜靜脈阻塞(RVO)繼髮黃斑水腫的安全性及臨床療效.方法 迴顧性繫列病例研究.確診的RVO繼髮黃斑水腫患者共30例(30眼),其中分支靜脈阻塞20例,中央靜脈阻塞10例.年齡34～79歲,平均(57.3±8.9)歲.玻璃體腔內註射Bevacizumab的劑量按照PrONTO研究組方法,為1.25 mg,3次註射後,根據眼底熒光造影(FFA)結果補充眼底激光治療.治療前和治療後1、3、6、12箇月對患者進行視力、眼底照相、相榦光學斷層掃描、FFA檢查.採用ETDRS視力錶進行視力檢查;採用光學相關斷層掃描儀測量黃斑區視網膜神經上皮層厚度(CRT).患者治療後各箇時間點的最佳矯正視力(BCVA)、CRT值與治療前基線值比較採用配對t檢驗,RVO患者各箇時間點的BCVA與CRT值的相關性採用直線迴歸分析.結果 30例RVO患者平均接受玻璃體腔內註射(3.9±1.9)次,視力提高15箇字符及以上者16眼(54％),視力提高5～10箇字符者10眼(33％),視力穩定在5箇字符以內者4眼(13％).治療後12箇月時,ETDRS視力為60±19,與治療前(42±19)相比,差異有統計學意義(t=7.87,P＜0.05).平均CRT值末次隨訪時為(268.9±115.9) μm,與治療前[(616.7±177.0)μm]相比,差異有統計學意義(t=13.23,P＜0.01).治療後12箇月BCVA與治療前BCVA的相關性存在統計學意義(r=0.791,P＜0.01),無論何種類型靜脈阻塞,基線視力、預後視力與治療前黃斑水腫程度均無相關性.末次隨訪時21眼(70％)黃斑區未見明顯囊性積液,9眼(30％)仍有少量囊性積液,FFA顯示複髮的主要原因為黃斑區小血管滲漏.治療及隨訪過程中未見明顯不良反應髮生.結論 對RVO繼髮黃斑水腫患者進行玻璃體腔內註射Bevacizumab聯閤眼底激光治療,可保存或改善視力,有效減輕黃斑水腫;黃斑區毛細血管滲漏是引起黃斑水腫複髮的主要原因,所以重複玻璃體腔註射是必需的.
목적 관찰파리체강내주사Bevacizumab연합안저격광치료시망막정맥조새(RVO)계발황반수종적안전성급림상료효.방법 회고성계렬병례연구.학진적RVO계발황반수종환자공30례(30안),기중분지정맥조새20례,중앙정맥조새10례.년령34～79세,평균(57.3±8.9)세.파리체강내주사Bevacizumab적제량안조PrONTO연구조방법,위1.25 mg,3차주사후,근거안저형광조영(FFA)결과보충안저격광치료.치료전화치료후1、3、6、12개월대환자진행시력、안저조상、상간광학단층소묘、FFA검사.채용ETDRS시력표진행시력검사;채용광학상관단층소묘의측량황반구시망막신경상피층후도(CRT).환자치료후각개시간점적최가교정시력(BCVA)、CRT치여치료전기선치비교채용배대t검험,RVO환자각개시간점적BCVA여CRT치적상관성채용직선회귀분석.결과 30례RVO환자평균접수파리체강내주사(3.9±1.9)차,시력제고15개자부급이상자16안(54％),시력제고5～10개자부자10안(33％),시력은정재5개자부이내자4안(13％).치료후12개월시,ETDRS시력위60±19,여치료전(42±19)상비,차이유통계학의의(t=7.87,P＜0.05).평균CRT치말차수방시위(268.9±115.9) μm,여치료전[(616.7±177.0)μm]상비,차이유통계학의의(t=13.23,P＜0.01).치료후12개월BCVA여치료전BCVA적상관성존재통계학의의(r=0.791,P＜0.01),무론하충류형정맥조새,기선시력、예후시력여치료전황반수종정도균무상관성.말차수방시21안(70％)황반구미견명현낭성적액,9안(30％)잉유소량낭성적액,FFA현시복발적주요원인위황반구소혈관삼루.치료급수방과정중미견명현불량반응발생.결론 대RVO계발황반수종환자진행파리체강내주사Bevacizumab연합안저격광치료,가보존혹개선시력,유효감경황반수종;황반구모세혈관삼루시인기황반수종복발적주요원인,소이중복파리체강주사시필수적.
Objective To evaluate the efficacy and safety of intravitreal injection of Bevacizumab (Avastin) combined with laser photocoagulation in the patients of macular edema secondary to retinal vein occlusion (RVO).Methods This was a retrospective cases-series study.Thirty eyes of 30 RVO patients (branch RVO 20 eyes and central RVO 10 eyes) were erolled,aged from 34 to 79,with average of (57.3±8.9)years.The eyes were treated with intravitreal injections of Bevacizumab (1.25 mg) combined with laser photocoagulation.The treatment method of intravitreal injection had been conducted according to PrONTO study.Best corrected visual acuity (BCVA,ETDRS letters),fundus photography,optical coherence tomography (OCT) were committed at baseline and 1,3,6,12 months after intravitreal injection.The ETDRS letters and the central retinal thickness (CRT) by OCT were recorded.Changes in BCVA and CRT measurements from baseline at the various follow-up endpoints were assessed with paired t test.Spearman correlation coefficient was used to measure the strength of correlation between BCVA and anatomic changes.Results The mean number of the injections in the 30 patients was 3.9±1.9.The BCVA improved 3 or more lines in 16 eyes (54％),improved 1 to 2 lines in 10 eyes (33％),stabilized (±1 line or no change) in 4 eyes (13％) and none decreased.The average BCVA at baseline was (42±19) letters,and improved to (60±19) letters at 12 months (t=7.87,P＜0.05).The average of retinal thickness of macular foveal decreased from (616.7±177.0)μm at baseline to (268.9±l15.9)μm at 12 months (t=13.23,P＜0.05).BCVA 12 months post-treatment was correlated to BCVA pre-treatment (r=0.791,P＜0.01).Macular edema had no correlation with baseline and finally BCVA.21 eyes (70％) showed no observed macular edema by the last follow-up and the side effects were not observed during the follow-up.Conclusion The persistent and rebound macular edema found in Bevacizumab treatment had some common characteristics in FFA. Combined intravitreal injections of Bevacizumab and laser photocoagulation therapy seemed to be effective for managing some refractory macular edema secondary to RVO.The Bevacizumab and photocoagulation related adverse events are rare.
