CAJ | 학술논문

目的观察光动力疗法(PDT)联合玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)治疗渗出型老年性黄斑变性(AMD)的疗效.方法临床确诊为渗出型AMD患者28例34只眼纳入研究.其中,典型性为主型脉络膜新生血管(CNV)者25只眼,轻微典型性CNV者9只眼.光相干断层扫描(OCT)检查结果显示黄斑区视网膜下液(SRF) 11只眼,视网膜内液(IRF) 23只眼.所有患者常规行PDT治疗后3～7 d再行玻璃体腔注射bevacizumab治疗.治疗后每1个月行最佳矫正视力(BCVA)和OCT检查.OCT检查发现SRF和(或)IRF增多,或连续注射2次后,积液较上次随访无明显变化,但视力下降≥1行者行再次玻璃体腔注射治疗;若无视网膜积液者,或连续2次复查显示积液较上次随访无明显变化,且视力无下降者停止治疗.对比分析治疗前和治疗后6个月患眼的视力变化情况、视网膜厚度变化和bevacizumab注射次数.分析治疗后视力的相关影响因素,BCVA、中心视网膜厚度(CRT)与CNV类型、治疗后视网膜是否有积液之间的关系;玻璃体腔注射bevacizumab次数与CNV类型、SRF、IRF之间的关系.结果治疗后6个月,患眼平均BCVA (44.9±21.3)个字母,较治疗前提高(9.4±10.2)个字母,差异有统计学意义(t=5.438,P＜0.01).患眼平均CRT为(177.1±95.8) μm,较治疗前下降(184.6±214.6) μm,差异有统计学意义(t=4.810,P＜0.01).患眼玻璃体腔注射bevacizumab总次数为63次,平均注射次数为(1.9±0.9)次.治疗后6个月的视力仅与治疗前视力相关(r=0.802,P＜0.01);与治疗前病灶大小(r=-0.183)、视网膜厚度(r=-0.089)、CNV分型(r=0.053)和OCT积液分型(r=0.139)均无相关性(P＞0.05).SRF患眼治疗后BCVA的变化多于IRF患眼,差异有统计学意义(t=-2.207,P=0.035).CNV类型(t=-0.076)、治疗后有无积液(t=l.159)与治疗后BCVA的变化无关(P＞0.05).治疗后CRT变化与CNV类型(t=-1.028)、OCT积液分型(t=-0.020)无关(P＞0.05).玻璃体腔注射bevacizumab的次数与CNV类型(Z=-1.505)、OCT积液分型(Z=-0.237)及治疗后视网膜是否有积液(Z=-1.194)均无相关性(P＞0.05).结论 PDT联合玻璃体腔注射bevacizumab治疗渗出型AMD可短期内提高患眼视力,降低患眼视网膜厚度. 目的觀察光動力療法(PDT)聯閤玻璃體腔註射抗血管內皮生長因子單剋隆抗體bevacizumab(商品名Avastin)治療滲齣型老年性黃斑變性(AMD)的療效.方法臨床確診為滲齣型AMD患者28例34隻眼納入研究.其中,典型性為主型脈絡膜新生血管(CNV)者25隻眼,輕微典型性CNV者9隻眼.光相榦斷層掃描(OCT)檢查結果顯示黃斑區視網膜下液(SRF) 11隻眼,視網膜內液(IRF) 23隻眼.所有患者常規行PDT治療後3～7 d再行玻璃體腔註射bevacizumab治療.治療後每1箇月行最佳矯正視力(BCVA)和OCT檢查.OCT檢查髮現SRF和(或)IRF增多,或連續註射2次後,積液較上次隨訪無明顯變化,但視力下降≥1行者行再次玻璃體腔註射治療;若無視網膜積液者,或連續2次複查顯示積液較上次隨訪無明顯變化,且視力無下降者停止治療.對比分析治療前和治療後6箇月患眼的視力變化情況、視網膜厚度變化和bevacizumab註射次數.分析治療後視力的相關影響因素,BCVA、中心視網膜厚度(CRT)與CNV類型、治療後視網膜是否有積液之間的關繫;玻璃體腔註射bevacizumab次數與CNV類型、SRF、IRF之間的關繫.結果治療後6箇月,患眼平均BCVA (44.9±21.3)箇字母,較治療前提高(9.4±10.2)箇字母,差異有統計學意義(t=5.438,P＜0.01).患眼平均CRT為(177.1±95.8) μm,較治療前下降(184.6±214.6) μm,差異有統計學意義(t=4.810,P＜0.01).患眼玻璃體腔註射bevacizumab總次數為63次,平均註射次數為(1.9±0.9)次.治療後6箇月的視力僅與治療前視力相關(r=0.802,P＜0.01);與治療前病竈大小(r=-0.183)、視網膜厚度(r=-0.089)、CNV分型(r=0.053)和OCT積液分型(r=0.139)均無相關性(P＞0.05).SRF患眼治療後BCVA的變化多于IRF患眼,差異有統計學意義(t=-2.207,P=0.035).CNV類型(t=-0.076)、治療後有無積液(t=l.159)與治療後BCVA的變化無關(P＞0.05).治療後CRT變化與CNV類型(t=-1.028)、OCT積液分型(t=-0.020)無關(P＞0.05).玻璃體腔註射bevacizumab的次數與CNV類型(Z=-1.505)、OCT積液分型(Z=-0.237)及治療後視網膜是否有積液(Z=-1.194)均無相關性(P＞0.05).結論 PDT聯閤玻璃體腔註射bevacizumab治療滲齣型AMD可短期內提高患眼視力,降低患眼視網膜厚度.
목적 관찰광동력요법(PDT)연합파리체강주사항혈관내피생장인자단극륭항체bevacizumab(상품명Avastin)치료삼출형노년성황반변성(AMD)적료효.방법 림상학진위삼출형AMD환자28례34지안납입연구.기중,전형성위주형맥락막신생혈관(CNV)자25지안,경미전형성CNV자9지안.광상간단층소묘(OCT)검사결과현시황반구시망막하액(SRF) 11지안,시망막내액(IRF) 23지안.소유환자상규행PDT치료후3～7 d재행파리체강주사bevacizumab치료.치료후매1개월행최가교정시력(BCVA)화OCT검사.OCT검사발현SRF화(혹)IRF증다,혹련속주사2차후,적액교상차수방무명현변화,단시력하강≥1행자행재차파리체강주사치료;약무시망막적액자,혹련속2차복사현시적액교상차수방무명현변화,차시력무하강자정지치료.대비분석치료전화치료후6개월환안적시력변화정황、시망막후도변화화bevacizumab주사차수.분석치료후시력적상관영향인소,BCVA、중심시망막후도(CRT)여CNV류형、치료후시망막시부유적액지간적관계;파리체강주사bevacizumab차수여CNV류형、SRF、IRF지간적관계.결과 치료후6개월,환안평균BCVA (44.9±21.3)개자모,교치료전제고(9.4±10.2)개자모,차이유통계학의의(t=5.438,P＜0.01).환안평균CRT위(177.1±95.8) μm,교치료전하강(184.6±214.6) μm,차이유통계학의의(t=4.810,P＜0.01).환안파리체강주사bevacizumab총차수위63차,평균주사차수위(1.9±0.9)차.치료후6개월적시력부여치료전시력상관(r=0.802,P＜0.01);여치료전병조대소(r=-0.183)、시망막후도(r=-0.089)、CNV분형(r=0.053)화OCT적액분형(r=0.139)균무상관성(P＞0.05).SRF환안치료후BCVA적변화다우IRF환안,차이유통계학의의(t=-2.207,P=0.035).CNV류형(t=-0.076)、치료후유무적액(t=l.159)여치료후BCVA적변화무관(P＞0.05).치료후CRT변화여CNV류형(t=-1.028)、OCT적액분형(t=-0.020)무관(P＞0.05).파리체강주사bevacizumab적차수여CNV류형(Z=-1.505)、OCT적액분형(Z=-0.237)급치료후시망막시부유적액(Z=-1.194)균무상관성(P＞0.05).결론 PDT연합파리체강주사bevacizumab치료삼출형AMD가단기내제고환안시력,강저환안시망막후도.
Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD).Methods In this retrospective study,34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab,including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT),23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF).After signing informed consent,all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days.Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly.Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT,or BCVA lowered more than 5 letters even with stabilized fluid.Injection was discontinued if no fluid was showed on OCT ("dry macular"),or BCVA was stabilized even with fluid after two consecutive injections.BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up.The correlation between parameters such as baseline BCVA,greatest linear dimension (GLD),type of CNV,SRF or IRF and post-treatment BCVA will be analyzed.The injection number of bevacizumab and complications were recorded.Results Compared to baseline,BCVA improved (9.4 ± 10.2) letters and reach 44.9±21.3 letters (t=5.438,P＜0.01) and CRT decreased (184.6±214.6) μm (t=4.810,P＜0.01) at 6 month visit.The average of injection number was 1.9 ± 0.9 (including initial injection of combination therapy).With multiple lineal regression analysis,only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802,P＜0.01).The type of CNV,GLD,SRF or IRF on OCT and CRTat baseline were not associated to post-treatment BCVA (r=0.053,-0.183,0.139 and 0.053,respectively,P＞0.05).BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207,P=0.035).The change of BCVA after treatment (t=-0.076),change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05).The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05).The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P ＞0.05).No severe complications were noticed during follow-up.Conclusion For wet AMD patients,PDT combined intravitreal bevacizumab could improve visual acuity,reduce retinal thickness and control CNV progress in a short-term.