中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2014年
3期
235-240
,共6页
孙祖华%林冰%李英姿%张逸夔%黄颖%周容%李明翰%刘晓玲
孫祖華%林冰%李英姿%張逸夔%黃穎%週容%李明翰%劉曉玲
손조화%림빙%리영자%장일기%황영%주용%리명한%류효령
脉络膜疾病/治疗%光化学疗法%抗体,单克隆%曲安奈德
脈絡膜疾病/治療%光化學療法%抗體,單剋隆%麯安奈德
맥락막질병/치료%광화학요법%항체,단극륭%곡안내덕
Choroid diseases/therapy%Photochemotherapy%Antibodies,monoclonal%Triamcinolone acetonide
目的 观察息肉样脉络膜血管病变(PCV)临床个性化治疗方案的效果.方法 临床检查确诊的PCV患者79例86只眼纳入研究.患者中,男性60例65只眼,女性19例21只眼.平均年龄(64.48±13.15)岁.均行最佳矫正视力(BCVA)、裂隙灯显微镜联合前置镜、眼底彩色照相、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)和(或)吲哚青绿血管造影(ICGA)检查.患眼平均BCVA 0.19±0.20.根据息眼所接受治疗情况不同分为单纯光动力疗法(PDT)治疗组(A组)、PDT联合玻璃体腔注射雷珠单抗治疗组(B组)、PDT联合后Tenons囊下注射曲安奈德治疗组(C组),分别为45、31、10只眼.治疗后1个月复查,以后根据临床需要定期复查.A组45只眼中,治疗后失访5只眼,其余治疗眼平均随访时间3.27个月.B组31只眼中,治疗后失访3只眼,其余治疗眼平均随访时间6.68个月.C组10只眼中,治疗后失访1只眼,其余治疗眼平均随访时间5.67个月.随访病情加重或复发者行FFA和(或)ICGA检查.对比分析患眼治疗前与治疗后1个月BCVA、中心凹视网膜厚度的变化;观察治疗后病灶消退、复发或加重的情况.结果 A组45只眼均接受1次治疗;B组31只眼中,接受1次治疗20只眼,占64.5％;C组10只眼中,接受1次治疗9只眼,占90.0％.治疗后1个月A、B、C组患眼BCVA与治疗前比较,差异有统计学意义(t=2.061、3.262、3.258,P＜0.05);3组间治疗后1个月患眼平均BCVA比较,差异无统计学意义(t=1.345、0.683、0.168,P＞0.05).治疗后1个月,A、B组患眼平均中心凹视网膜厚度与治疗前比较,差异有统计学意义(t=2.239、4.334,P＜0.05);C组患眼平均中心凹视网膜厚度与治疗前比较,差异无统计学意义(t=2.286,P＞0.05).FFA和(或)ICGA检查结果显示,A组接受检查的13只跟中,息肉样病灶、色素上皮脱离(PED)消退3只眼;息肉样病灶、PED减少4只眼;息肉样病灶仍然存在3只眼;息肉样病灶伴PED加重3只眼.B组接受检查的10只眼中,息肉样病灶消退3只眼;息肉样病灶减少3只眼;息肉样病灶消退后复发4只眼.C组接受检查的5只眼中,息肉样病灶消退4只眼;息肉样病灶消退后复发1只眼.结论 单纯PDT、PDT联合玻璃体腔注射雷珠单抗或后Tenons囊下注射TA均能不同程度使息肉样病灶消退或渗漏减轻;患眼视力稳定或提高.
目的 觀察息肉樣脈絡膜血管病變(PCV)臨床箇性化治療方案的效果.方法 臨床檢查確診的PCV患者79例86隻眼納入研究.患者中,男性60例65隻眼,女性19例21隻眼.平均年齡(64.48±13.15)歲.均行最佳矯正視力(BCVA)、裂隙燈顯微鏡聯閤前置鏡、眼底綵色照相、光相榦斷層掃描(OCT)、熒光素眼底血管造影(FFA)和(或)吲哚青綠血管造影(ICGA)檢查.患眼平均BCVA 0.19±0.20.根據息眼所接受治療情況不同分為單純光動力療法(PDT)治療組(A組)、PDT聯閤玻璃體腔註射雷珠單抗治療組(B組)、PDT聯閤後Tenons囊下註射麯安奈德治療組(C組),分彆為45、31、10隻眼.治療後1箇月複查,以後根據臨床需要定期複查.A組45隻眼中,治療後失訪5隻眼,其餘治療眼平均隨訪時間3.27箇月.B組31隻眼中,治療後失訪3隻眼,其餘治療眼平均隨訪時間6.68箇月.C組10隻眼中,治療後失訪1隻眼,其餘治療眼平均隨訪時間5.67箇月.隨訪病情加重或複髮者行FFA和(或)ICGA檢查.對比分析患眼治療前與治療後1箇月BCVA、中心凹視網膜厚度的變化;觀察治療後病竈消退、複髮或加重的情況.結果 A組45隻眼均接受1次治療;B組31隻眼中,接受1次治療20隻眼,佔64.5％;C組10隻眼中,接受1次治療9隻眼,佔90.0％.治療後1箇月A、B、C組患眼BCVA與治療前比較,差異有統計學意義(t=2.061、3.262、3.258,P＜0.05);3組間治療後1箇月患眼平均BCVA比較,差異無統計學意義(t=1.345、0.683、0.168,P＞0.05).治療後1箇月,A、B組患眼平均中心凹視網膜厚度與治療前比較,差異有統計學意義(t=2.239、4.334,P＜0.05);C組患眼平均中心凹視網膜厚度與治療前比較,差異無統計學意義(t=2.286,P＞0.05).FFA和(或)ICGA檢查結果顯示,A組接受檢查的13隻跟中,息肉樣病竈、色素上皮脫離(PED)消退3隻眼;息肉樣病竈、PED減少4隻眼;息肉樣病竈仍然存在3隻眼;息肉樣病竈伴PED加重3隻眼.B組接受檢查的10隻眼中,息肉樣病竈消退3隻眼;息肉樣病竈減少3隻眼;息肉樣病竈消退後複髮4隻眼.C組接受檢查的5隻眼中,息肉樣病竈消退4隻眼;息肉樣病竈消退後複髮1隻眼.結論 單純PDT、PDT聯閤玻璃體腔註射雷珠單抗或後Tenons囊下註射TA均能不同程度使息肉樣病竈消退或滲漏減輕;患眼視力穩定或提高.
목적 관찰식육양맥락막혈관병변(PCV)림상개성화치료방안적효과.방법 림상검사학진적PCV환자79례86지안납입연구.환자중,남성60례65지안,녀성19례21지안.평균년령(64.48±13.15)세.균행최가교정시력(BCVA)、렬극등현미경연합전치경、안저채색조상、광상간단층소묘(OCT)、형광소안저혈관조영(FFA)화(혹)신타청록혈관조영(ICGA)검사.환안평균BCVA 0.19±0.20.근거식안소접수치료정황불동분위단순광동력요법(PDT)치료조(A조)、PDT연합파리체강주사뢰주단항치료조(B조)、PDT연합후Tenons낭하주사곡안내덕치료조(C조),분별위45、31、10지안.치료후1개월복사,이후근거림상수요정기복사.A조45지안중,치료후실방5지안,기여치료안평균수방시간3.27개월.B조31지안중,치료후실방3지안,기여치료안평균수방시간6.68개월.C조10지안중,치료후실방1지안,기여치료안평균수방시간5.67개월.수방병정가중혹복발자행FFA화(혹)ICGA검사.대비분석환안치료전여치료후1개월BCVA、중심요시망막후도적변화;관찰치료후병조소퇴、복발혹가중적정황.결과 A조45지안균접수1차치료;B조31지안중,접수1차치료20지안,점64.5％;C조10지안중,접수1차치료9지안,점90.0％.치료후1개월A、B、C조환안BCVA여치료전비교,차이유통계학의의(t=2.061、3.262、3.258,P＜0.05);3조간치료후1개월환안평균BCVA비교,차이무통계학의의(t=1.345、0.683、0.168,P＞0.05).치료후1개월,A、B조환안평균중심요시망막후도여치료전비교,차이유통계학의의(t=2.239、4.334,P＜0.05);C조환안평균중심요시망막후도여치료전비교,차이무통계학의의(t=2.286,P＞0.05).FFA화(혹)ICGA검사결과현시,A조접수검사적13지근중,식육양병조、색소상피탈리(PED)소퇴3지안;식육양병조、PED감소4지안;식육양병조잉연존재3지안;식육양병조반PED가중3지안.B조접수검사적10지안중,식육양병조소퇴3지안;식육양병조감소3지안;식육양병조소퇴후복발4지안.C조접수검사적5지안중,식육양병조소퇴4지안;식육양병조소퇴후복발1지안.결론 단순PDT、PDT연합파리체강주사뢰주단항혹후Tenons낭하주사TA균능불동정도사식육양병조소퇴혹삼루감경;환안시력은정혹제고.
Objective To observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).Methods Eighty-six eyes of 79 patients with PCV were enrolled in this study.There were 60 males (65 eyes) and 19 females (21 eyes).The average age was (64.48±13.15) years old.Best corrected visual acuity (BCVA),slit lamp ophthalmoscopy,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured.The average BCVA was 0.19 ± 0..20.There were three groups in this study including photodynamic therapy (PDT) group (group A,45 eyes),PDT and intravitreal ranibizumab injection group (group B,31 eyes),and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C,10 eyes).Follow up begun at 1 month after the treatment.40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months.9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months.Patients with recurrent or worsen lesions were followed by FFA or ICGA.Pre-and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.Results All eyes (100.0 ％) in group A,20 eyes (64.52％) in group B and 9 eyes (90.00％) in group C received treatment only once.The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061,3.262,3.258; P＜0.05),but no significant difference was found between the 3 groups (t=1.345,0.683,0.168; P＞0.05).Compared to pre-treatment measures,the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239,4.334; P＜0.05),but not changed in group C (t=2.286,P＞0.05) at 1 month after treatment.Thirteen eyes in group A were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED),4 eyes with partial closed PCV,3 eyes with stable PCV and 3 eyes with worsen PCV.Ten eyes in group B were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV,3 eyes with partial closed PCV,4 eyes with recurrence PCV.Five eyes in group C were followed by FFA and (or) ICGA,which showed that there were 4 eyes with complete closed PCV,1 eyes with recurrence PCV.Conclusion All 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.
