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
245-248
,共4页
王琴慧%喻晓兵%戴虹%龙力
王琴慧%喻曉兵%戴虹%龍力
왕금혜%유효병%대홍%룡력
脉络膜疾病/治疗%光化学疗法%抗体,单克隆
脈絡膜疾病/治療%光化學療法%抗體,單剋隆
맥락막질병/치료%광화학요법%항체,단극륭
Choroid diseases/therapy%Photochemotherapy%Antibodies,monoclonal
目的 观察光动力疗法(PDT)联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变(PCV)的安全性和有效性.方法 回顾性系列病例研究.临床确诊为PCV的患者24例24只眼纳入研究.所有患者均行视力、眼底彩色照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查.视力检查采用糖尿病视网膜病变早期治疗研究组视力表进行.患者治疗前平均视力为(33.41±19.43)个字母,平均黄斑视网膜厚度(CRT)为(343.63±88.60) μm.所有患者先行常规PDT治疗,72 h后玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml(含雷珠单抗0.5 mg).根据检查情况确定是否需要重复行单独玻璃体腔注射雷珠单抗或PDT联合玻璃体腔注射雷珠单抗治疗.治疗后平均随访时间为13.1个月.观察统计每只眼的平均治疗次数、患者并发症及全身不良反应的发生情况.对比分析治疗前后患者视力和CRT的变化,以及黄斑区出血及渗出、PCV病灶的渗漏情况.结果 每只眼平均重复玻璃体腔注射雷珠单抗治疗次数为(2.8±1.6)次,平均重复联合治疗次数为(0.4±0.5)次.所有患眼均未出现与治疗相关的并发症和全身不良反应.末次随访时,患眼视力为(44.21±17.24)个字母,较治疗前平均提高10.8个字母.治疗前后视力比较,差异有统计学意义(t=-4.77,P＜0.01).24只眼中,视力提高11只眼,占45.8％;视力稳定13只跟,占54.2％.眼底检查发现,黄斑区出血、渗出完全吸收7只眼,占29.2％;黄斑区出血、渗出明显减轻17只眼,占70.8％.FFA及ICGA检查发现,荧光渗漏停止17只眼,占70.8％;仍有轻微荧光渗漏7只眼,占29.2％.OCT检查发现,视网膜下积液消退19只眼,占79.2％;视网膜下积液减轻5只跟,占20.8％.患者平均CRT为(171.33±38.06) μm,较治疗前平均降低172.30 μm.治疗前后平均CRT比较,差异有统计学意义(t=11.96,P＜0.05).结论 PDT联合玻璃体腔注射雷珠单抗治疗PCV安全有效,可提高患者视力,减轻视网膜水肿,停止或减少PCV病灶渗漏.
目的 觀察光動力療法(PDT)聯閤玻璃體腔註射雷珠單抗治療息肉樣脈絡膜血管病變(PCV)的安全性和有效性.方法 迴顧性繫列病例研究.臨床確診為PCV的患者24例24隻眼納入研究.所有患者均行視力、眼底綵色照相、熒光素眼底血管造影(FFA)、吲哚青綠血管造影(ICGA)和光相榦斷層掃描(OCT)檢查.視力檢查採用糖尿病視網膜病變早期治療研究組視力錶進行.患者治療前平均視力為(33.41±19.43)箇字母,平均黃斑視網膜厚度(CRT)為(343.63±88.60) μm.所有患者先行常規PDT治療,72 h後玻璃體腔註射10 mg/ml的雷珠單抗0.05 ml(含雷珠單抗0.5 mg).根據檢查情況確定是否需要重複行單獨玻璃體腔註射雷珠單抗或PDT聯閤玻璃體腔註射雷珠單抗治療.治療後平均隨訪時間為13.1箇月.觀察統計每隻眼的平均治療次數、患者併髮癥及全身不良反應的髮生情況.對比分析治療前後患者視力和CRT的變化,以及黃斑區齣血及滲齣、PCV病竈的滲漏情況.結果 每隻眼平均重複玻璃體腔註射雷珠單抗治療次數為(2.8±1.6)次,平均重複聯閤治療次數為(0.4±0.5)次.所有患眼均未齣現與治療相關的併髮癥和全身不良反應.末次隨訪時,患眼視力為(44.21±17.24)箇字母,較治療前平均提高10.8箇字母.治療前後視力比較,差異有統計學意義(t=-4.77,P＜0.01).24隻眼中,視力提高11隻眼,佔45.8％;視力穩定13隻跟,佔54.2％.眼底檢查髮現,黃斑區齣血、滲齣完全吸收7隻眼,佔29.2％;黃斑區齣血、滲齣明顯減輕17隻眼,佔70.8％.FFA及ICGA檢查髮現,熒光滲漏停止17隻眼,佔70.8％;仍有輕微熒光滲漏7隻眼,佔29.2％.OCT檢查髮現,視網膜下積液消退19隻眼,佔79.2％;視網膜下積液減輕5隻跟,佔20.8％.患者平均CRT為(171.33±38.06) μm,較治療前平均降低172.30 μm.治療前後平均CRT比較,差異有統計學意義(t=11.96,P＜0.05).結論 PDT聯閤玻璃體腔註射雷珠單抗治療PCV安全有效,可提高患者視力,減輕視網膜水腫,停止或減少PCV病竈滲漏.
목적 관찰광동력요법(PDT)연합파리체강주사뢰주단항치료식육양맥락막혈관병변(PCV)적안전성화유효성.방법 회고성계렬병례연구.림상학진위PCV적환자24례24지안납입연구.소유환자균행시력、안저채색조상、형광소안저혈관조영(FFA)、신타청록혈관조영(ICGA)화광상간단층소묘(OCT)검사.시력검사채용당뇨병시망막병변조기치료연구조시력표진행.환자치료전평균시력위(33.41±19.43)개자모,평균황반시망막후도(CRT)위(343.63±88.60) μm.소유환자선행상규PDT치료,72 h후파리체강주사10 mg/ml적뢰주단항0.05 ml(함뢰주단항0.5 mg).근거검사정황학정시부수요중복행단독파리체강주사뢰주단항혹PDT연합파리체강주사뢰주단항치료.치료후평균수방시간위13.1개월.관찰통계매지안적평균치료차수、환자병발증급전신불량반응적발생정황.대비분석치료전후환자시력화CRT적변화,이급황반구출혈급삼출、PCV병조적삼루정황.결과 매지안평균중복파리체강주사뢰주단항치료차수위(2.8±1.6)차,평균중복연합치료차수위(0.4±0.5)차.소유환안균미출현여치료상관적병발증화전신불량반응.말차수방시,환안시력위(44.21±17.24)개자모,교치료전평균제고10.8개자모.치료전후시력비교,차이유통계학의의(t=-4.77,P＜0.01).24지안중,시력제고11지안,점45.8％;시력은정13지근,점54.2％.안저검사발현,황반구출혈、삼출완전흡수7지안,점29.2％;황반구출혈、삼출명현감경17지안,점70.8％.FFA급ICGA검사발현,형광삼루정지17지안,점70.8％;잉유경미형광삼루7지안,점29.2％.OCT검사발현,시망막하적액소퇴19지안,점79.2％;시망막하적액감경5지근,점20.8％.환자평균CRT위(171.33±38.06) μm,교치료전평균강저172.30 μm.치료전후평균CRT비교,차이유통계학의의(t=11.96,P＜0.05).결론 PDT연합파리체강주사뢰주단항치료PCV안전유효,가제고환자시력,감경시망막수종,정지혹감소PCV병조삼루.
Objective To observe the efficacy and safety of combined photodynamic therapy (PDT)with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV).Methots Twenty-four PCV patients (24 eyes) were enrolled in this retrospective case study.All patients were assessed by the examinations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart,color fundus photography,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optic coherence tomography (OCT).The mean visual acuity was (33.41± 19.43) letters; the mean macular retinal thickness was (343.63 ± 88.60) μm.Patients received PDT first,and intravitreal injected ranibizumab 0.5 mg (0.05 ml) 72 hours later.Treatments were repeated as a single intravitreal injection of ranibizumab combined with or without PDT if the monthly follow-up indicated that it was necessary.The average follow-up period was 13.1 months.The average treatment times were analyzed for each eye.Systemic and ocular adverse events were observed.Visual acuity,macular retinal thickness and leakage of PCV before and after the treatment were analyzed.Results Intravitreal ranibizumab injections was repeated (2.8± 1.6) times per eye on average,and intravitreal injection of ranibizumab combined with PDT was repeated (0.4±0.5) times per eye on average.No systemic and ocular adverse effects were found during and after combined therapy.In the last follow-up,the mean visual acuity of ETDRS was (44.21±17.24)letters,improved by 10.8 letters (t=-4.77,P＜0.01).Visual acuity was improved in 11 eyes (45.8％) and stable in 13 eyes (54.2％).FFA and ICGA showed complete closed PCV in 17 eyes (70.8％),partial closed PCV in 7 eyes (29.2％).OCT image showed that the retinal edema was disappeared in 19 eyes (79.2％) and alleviated in 5 eyes (20.8％).The mean macular retinal thickness was (171.33±38.06) μm,which was 172.30 μm less than that of pre-treatment values (t =11.96,P＜ 0.05).Conclusion Photodynamic therapy combined with intravitreal ranibizumab injections for PCV is safe and effective,with visual acuity improvement,reduction of retinal edema and PCV leakage.
