光动力疗法联合玻璃体腔注射抗血管内皮生长因子单克隆抗体Bevacizumab治疗渗出型老年性黄斑变性的临床观察

Clinical observation of photodynamic therapy combined with intravitreal injection of bevacizumab for neovascular age-related macular degeneration

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治疗渗出型老年性黄斑变性（AMD）脉络膜新生血管（CNV）的安全性和临床疗效。方法经视力、眼压、眼底检查、眼底彩色照相、荧光素眼底血管造影（FFA）或（和）吲哚青绿血管造影（ICGA）、光相干断层扫描（OCT）检查确诊的21例渗出型AMD患者的21只眼纳入治疗。患者中男性15例15只眼，女性6例6只眼。年龄56～78岁，平均年龄68．6岁。矫正视力：数指／10cm～0．9，logMAR视力为0．89±0．21。病程10d～2年。平均眼压（14．96±2．65）mmHg（1mmHg=0．133kPa）。CNV位于黄斑中心凹下或中心凹旁，FFA或（和）ICGA检查均有明显的荧光素渗漏；平均黄斑中心凹视网膜厚度（228．45±18．54）μm。PDT治疗按照PDT治疗AMD（TAP）研究组和维替泊芬PDT治疗（VIP）研究组的方法进行。3d后在表面麻醉下给予1．5mg Bevacizumab玻璃体腔注射。治疗后第1、3、6、12个月随访。结果末次随访时，矫正视力：数指／10cm～1．5，logMAR视力为0．42±0．18，与治疗前平均视力比较，差异有统计学意义（P〈0．01）。其中，视力提高4行以上者6只眼，占28．57％；提高2～4行者9只眼，占42．86％；视力稳定或波动在1行以内者6只眼，占28．57％；无视力下降者。治疗后平均眼压（15．20±2．41）mmHg，与治疗前平均眼压比较，差异无统计学意义（P〉0．05）。FFA或（和）ICGA检查CNV完全闭合13只眼，占61．90％；大部分闭合8只眼，占38．10％。平均黄斑中心凹视网膜厚度（157．67±19．32）μm，与手术前平均黄斑中心凹厚度比较，差异有统计学意义（P〈0．01）。结论PDT联合玻璃体腔注射Bevacizumab治疗渗出型AMD的CNV疗效较好，能较明显提高视力，促使CNV渗漏停止或减轻，促使视网膜水肿消退或减轻，安全性高。

Objective To evaluate the efficacy and safety of photodynamic therapy （PDT） combined with intravitreal injection of hevacizumah for choroidal neovascularization （CNV） caused by agerelated macular degeneration （AMD）. Methods A total of 21 eyes of 21 patients with AMD, which was diagnosed by examination of visual acuity, intraocular pressure, ocular fundus, fundus color photography, fundus fluorescein angiography （FFA）, indocyanine green angiography （ICGA）and optic coherence tomography （OCT）, were underwent PDT combined with intravitreal injection of Bevacizumab. The patients, 15 males （15 eyes） and 6 females （6 eyes）, aged from 56 to 78 years, with the average of 68.6 years. The best corrected visual acuity：counting fingers/10cm-0. 9, logMAR was 1. 04 ±0. 41. CNV located in below or side central fovea of macula. There was obvious leakage of fluorescein which examined by FFA and ICGA. The average of retinal thickness of macular foveal was （258. 91± 78.66）μm. The treatment method of PDT has to according to the way of PDT for TAP and Verteporfin PDT for VIP. Intravitreal infection with 1.5mg hevacizumah was performed after three days under surface anesthesia. Follow-up time was 1, 3, 6, 12 months after the treatment. Results At last visit, the best corrected visual acuity：counting fingers/10 cm-1.5, logMAR was 1.04±0.41, and the differences are statistically significant compared with before. The BCVA improved four or morc lines in 6 eyes （28.57%）, improved two to four lines in 9 eyes （42.86%）, stabilized （± 1 line or no change） in 6 eyes （28.57%） and decreased in none. The average intraocular pressure was （15.20±2.41 ）mmHg after surgery, and the differences was not statistically significant compared with before（P〉0.05）. FFA and ICGA showed CNV complete closure in 13 eyes （61.90%）, partial closure in 8 eyes （38. 10%）. The average of retinal thickness uf macular foveal was（127.38±20. 14） μm （P〈0.01）. Conclusion Combining treatment with PDT and intravitreal injection of Bevacizumab is safe and effective for CNV which caused by AMD. h has significant improvement in BCVA, leakage of CNV and retinal edema.