CAJ | 학술논문

目的观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(IVB)治疗渗出型老年性黄斑变性(AMD)的效果,分析治疗无效的原因.方法开放性、单一治疗组的前瞻性研究.经最佳矫正视力(BCVA)、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及光相干断层扫描(OCT)检查确诊为渗出型AMD的17例患者18只眼纳入研究.确诊并取得患者知情同意后行第1次IVB治疗.此后第6、12、24、36、48周分别行第2、3、4、5、6次IVB治疗.治疗前及每次治疗后均行BCVA、眼压、裂隙灯显微镜、眼底、彩色眼底照相、OCT检查,于治疗前及第6、24、52周行FFA和ICGA检查.以末次随访患者BCVA所见字母数增加、不变或减少＜5个为治疗有效,字母数减少≥5个为治疗无效；观察其治疗效果.对比分析治疗无效患眼治疗前后OCT测得的黄斑中心凹视网膜厚度(CMT)、病变最大处视网膜厚度( MRT)变化以及FFA和ICGA的形态学变化情况.结果 18只眼中,有效12只眼,占66.67％；无效6只眼,占33.33％.无效眼治疗前平均CMT、MRT为506.83、635.33μtm,治疗后平均CMT、MRT为446.17、563.67 μm;治疗后较治疗前分别降低了60.67、71.67 μm,差异均无统计学意义(t=-1.572,-0.943；P=0.116,0.345).FFA及ICGA检查发现,治疗无效的6只眼中,3只眼病灶位于黄斑中心凹区域内,整个治疗过程中未见病灶反复活动,第6次治疗后病灶均出现大片状瘢痕化.另3只眼在第3次治疗后黄斑区病灶面积扩大,荧光渗漏,CNV呈花环样；第6次治疗后,黄斑区荧光渗漏较第3次治疗后减轻,部分病灶瘢痕化.OCT检查发现,治疗无效眼神经上皮脱离减轻,视网膜色素上皮与脉络膜光带较治疗前光滑,但仍有增厚、隆起,黄斑区视网膜水肿.结论 IVB治疗渗出型AMD具有一定的有效性.治疗无效的原因可能与CNV活动性强、病灶范围扩大以及病灶位于黄斑中心凹区域内有关. 目的觀察玻璃體腔註射抗血管內皮生長因子單剋隆抗體bevacizumab(IVB)治療滲齣型老年性黃斑變性(AMD)的效果,分析治療無效的原因.方法開放性、單一治療組的前瞻性研究.經最佳矯正視力(BCVA)、熒光素眼底血管造影(FFA)、吲哚青綠血管造影(ICGA)及光相榦斷層掃描(OCT)檢查確診為滲齣型AMD的17例患者18隻眼納入研究.確診併取得患者知情同意後行第1次IVB治療.此後第6、12、24、36、48週分彆行第2、3、4、5、6次IVB治療.治療前及每次治療後均行BCVA、眼壓、裂隙燈顯微鏡、眼底、綵色眼底照相、OCT檢查,于治療前及第6、24、52週行FFA和ICGA檢查.以末次隨訪患者BCVA所見字母數增加、不變或減少＜5箇為治療有效,字母數減少≥5箇為治療無效；觀察其治療效果.對比分析治療無效患眼治療前後OCT測得的黃斑中心凹視網膜厚度(CMT)、病變最大處視網膜厚度( MRT)變化以及FFA和ICGA的形態學變化情況.結果 18隻眼中,有效12隻眼,佔66.67％；無效6隻眼,佔33.33％.無效眼治療前平均CMT、MRT為506.83、635.33μtm,治療後平均CMT、MRT為446.17、563.67 μm;治療後較治療前分彆降低瞭60.67、71.67 μm,差異均無統計學意義(t=-1.572,-0.943；P=0.116,0.345).FFA及ICGA檢查髮現,治療無效的6隻眼中,3隻眼病竈位于黃斑中心凹區域內,整箇治療過程中未見病竈反複活動,第6次治療後病竈均齣現大片狀瘢痕化.另3隻眼在第3次治療後黃斑區病竈麵積擴大,熒光滲漏,CNV呈花環樣；第6次治療後,黃斑區熒光滲漏較第3次治療後減輕,部分病竈瘢痕化.OCT檢查髮現,治療無效眼神經上皮脫離減輕,視網膜色素上皮與脈絡膜光帶較治療前光滑,但仍有增厚、隆起,黃斑區視網膜水腫.結論 IVB治療滲齣型AMD具有一定的有效性.治療無效的原因可能與CNV活動性彊、病竈範圍擴大以及病竈位于黃斑中心凹區域內有關.
목적 관찰파리체강주사항혈관내피생장인자단극륭항체bevacizumab(IVB)치료삼출형노년성황반변성(AMD)적효과,분석치료무효적원인.방법 개방성、단일치료조적전첨성연구.경최가교정시력(BCVA)、형광소안저혈관조영(FFA)、신타청록혈관조영(ICGA)급광상간단층소묘(OCT)검사학진위삼출형AMD적17례환자18지안납입연구.학진병취득환자지정동의후행제1차IVB치료.차후제6、12、24、36、48주분별행제2、3、4、5、6차IVB치료.치료전급매차치료후균행BCVA、안압、렬극등현미경、안저、채색안저조상、OCT검사,우치료전급제6、24、52주행FFA화ICGA검사.이말차수방환자BCVA소견자모수증가、불변혹감소＜5개위치료유효,자모수감소≥5개위치료무효；관찰기치료효과.대비분석치료무효환안치료전후OCT측득적황반중심요시망막후도(CMT)、병변최대처시망막후도( MRT)변화이급FFA화ICGA적형태학변화정황.결과 18지안중,유효12지안,점66.67％；무효6지안,점33.33％.무효안치료전평균CMT、MRT위506.83、635.33μtm,치료후평균CMT、MRT위446.17、563.67 μm;치료후교치료전분별강저료60.67、71.67 μm,차이균무통계학의의(t=-1.572,-0.943；P=0.116,0.345).FFA급ICGA검사발현,치료무효적6지안중,3지안병조위우황반중심요구역내,정개치료과정중미견병조반복활동,제6차치료후병조균출현대편상반흔화.령3지안재제3차치료후황반구병조면적확대,형광삼루,CNV정화배양；제6차치료후,황반구형광삼루교제3차치료후감경,부분병조반흔화.OCT검사발현,치료무효안신경상피탈리감경,시망막색소상피여맥락막광대교치료전광활,단잉유증후、륭기,황반구시망막수종.결론 IVB치료삼출형AMD구유일정적유효성.치료무효적원인가능여CNV활동성강、병조범위확대이급병조위우황반중심요구역내유관.
Objective To observe the effect of intravitreal bevacizumab (IVB) for exudative agerelated macular degeneration (eAMD),and analyze the reasons for treatment failure.Methods Eighteen eyes of 17 patients with eAMD who have been diagnosed by fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled in this openlabel,single treatment group and prospective study.The patients received the first IVB treatment after diagnosis,and received the 2nd,3rd,4th,5th and 6th IVB treatment at 6,12,24,36,48 weeks after the first injection.The examinations of best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,fundus photography,FFA,ICGA and OCT were performed before and after treatment.Nonresponders were defined as patients who had BCVA loss more than 5 letters at week 52 compared with BCVA before treatment.The therapeutic effects of IVB for eAMD were observed.The central macular thickness (CMT),maximum retinal thickness (MRT) and morphological changes of FFA,ICGA and OCT before and after treatment were comparative analyzed.Results Of the 18 eyes,12 eyes (66.67％) were effective to IVB,6 eyes (33.33％) were non-responders.The average CMT and MRT of non-responders were 506.83,635.33 μm before treatment,which decreased to 446.17,563.67 μtm at 52 weeks.They were reduced by 60.67 and 71.67 μtm respectively,but there was no statistically significant differences (t =-1.572,-0.943; P=0.116,0.345).FFA and ICGA examination found that the CNV lesions of 3 nonresponder eyes located in the foveal region,and became scars after the 6th treatment.The other 3 nonresponder eyes developed CNV repeatedly during the treatments,and after the 6th injections of bevacizumab the lesions were under control with less fluorescein leakage and macular retinal edema.Conclusion IVB treatment is effectivefor some eAMD patients,but is ineffective for patients with extensive expanded CNV and foveal CNV.