光动力疗法联合Bevacizumab玻璃体腔注射治疗脉络膜新生血管观察

Preliminary result of combined photodynamic therapy with verteporfin and intravitreal bevacizumab （ avastin ） for choroidal neovascularization diseases

目的评价光动力疗法联合Bevacizumab（Avastin）玻璃体腔注射治疗脉络膜新生血管疾病的疗效。方法对连续病例29例（29只眼）经光动力疗法（photodynamic therapy，PDT）联合Avastin玻璃体腔注射治疗的中心凹下或旁中心凹脉络膜新生血管（choroidal neovascularization，CNV）患者资料进行回顾性分析。其中年龄相关性黄斑变性（age—related macular degeneration，AMD）15例（15只眼），男性10例，女性5例，平均年龄为63-3岁，有2例曾接受1次光动力疗法，其余未接受任何治疗；特发性脉络膜新生血管（idiopathic choroidal neovascularization，ICNV）14例（14只眼），男性6例，女性8例，平均年龄为28岁，有1例曾接受2次光动力疗法，其余未接受任何治疗。所有患者在光动力疗法后1周内行Avastin玻璃体腔注射（1．5mg／0．06m1）。疗效以视力稳定及再治疗次数作为标准。结果经3～6个月随访，29例患者中28例（96．5％）视力稳定或提高，27例（93．1％）视力提高。15例AMD患者中14例（93．3％）视力稳定或提高，13例（86．7％）视力提高，7例（46．7％）视力提高2行以上；1例（6．7％）治疗前后均为眼前指数的视力，1例（6．7％）视力从0．2降至0．1，病变稳定。10例（66．7％）通过一次联合治疗后CNV消退，随访期间较基线视力提高平均1．8行；3例（20％）3个月后需再次联合治疗。14例ICNV中14例（100％）视力稳定或提高，13例（92．8％）视力提高2行以上，随访期间较基线视力提高平均4．21行。13例（92．8％）通过一次联合治疗而使CNV消退。治疗及随访期间未见与PDT及Avastin相关的不良反应，亦未见眼内炎、眼压升高等并发症。结论本研究结果提示，PDT联合Avastin玻璃体腔注射治疗脉络膜新生血管的疗效显著，可以提高患者视力及减少再治疗次数。

Objective To evaluate the preliminary results for patients treated with combined photodynamic therapy （PDT）with verteporfin and intravitreal bevacizumab （Avastin）for choroidal neovascularization （CNV）diseases.Methods This is a retrospective series of 29 cases （29 eyes）with juxtafoveal or subfoveal CNV. Patients were treated with PDT with verteporfin and 1.5 mg （0.06ml）of intravitreal bevacizumab. Among them there were 15 cases of age-related macular degenerization （ AMD ）with an average age of 63.3 ,of which 10 cases were male and 5 cases were female. Two cases of AMD accepted one PDT before treatment and the other were naive to treatment. Another 14 cases were the young patients with idiopathic CNV （ICNV）with an average age of 28, of which 6 cases were male and 8 cases were female. One case of ICNV accepted two PDT before treatment and the other were naive to treatment. All the patients accepted PDT first and had intravitreal bevacizumab （Avastin）within one week. Main outcome measures were visual acuity stabilization （defined as no change or a gain in visual acuity）and retreatment rate.Result At the 3-6 months follow-up, 28 （ 96.5% ）of 29 patients had stabilization of visual acuity. Twenty-seven eyes （93.1% ） had improvement in visual acuity. Among the AMD, 93.3% （14/15）had stabilization of visual acuity and 86. 7%（ 13/15 ）had improvement in visual acuity. Sevencases（46.7%, 7/15 ）had improvement in visual acuity more than 2 lines. Ten cases （66.7%）required only a single combined treatment for CNV resolution. Mean improvemment in visual acuity in AMD （n=15 ）was 1.8 lines.Three cases of AMD needed retreatment during the follow-up. In ICNV group,100% （14/14）had stabilization of visual acuity and 92.8% （13/14）had improvement in visual acuity more than 2 lines. Mean improvemment in visual acuity in ICNV（n=14 ）was 4.21 lines. Thirdteen eyes （92.8%）of ICNV required only a single combined treatment for CNV resolution. There were no complication related to PDT and intravitreal avastin,including endophthalmitis,uveitis,and ocular hypertension.Conclusion The results of this study suggest that combined treatment of PDT with verteporfin and intravitreal avastin may be useful in treating diseases with CNV by improving visual acuity and reducing retreatment rates. Further investigation with large, long-term follow-up, controlled rials is warranted to outline the appropriate trentment paradigm for combination therapy.