玻璃体腔注射bevacizumab治疗特发性脉络膜新生血管膜的临床观察

Study on intravitreal bevacizumab for idiopathic choroidal neovascularization

目的观察玻璃体腔注射bevacizumab治疗特发性脉络膜新生血管(CNV)的临床效果。方法采用单中心非随机对照临床回顾性研究,对经间接检眼镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊的特发性CNV患者共43例(45眼),病程5d～3年,均为中心凹下CNV和旁中心凹下CNV。行bevacizumab玻璃体腔注射1.25mg(0.05mL),注射次数为1～5次,间隔6周,治疗后随访3～12个月,对比分析术前术后的视力、眼底、FFA及OCT表现。结果平均logMAR视力,术前为0.66±0.35,术后为0.29±0.27,术前术后比较差异有统计学意义(P<0.01)。视力平均提高(3.5±2.4)行。OCT显示平均中央视网膜厚度(CFT),术前为(358±103)μm,术后为(229±114)μm,术前术后比较差异有统计学意义(P<0.01)。CFT平均下降(129±116)μm。FFA显示渗漏消失者24眼,减少者17眼,渗漏持续者4眼。眼局部除3例有小片结膜下出血外,未出现其他并发症。结论玻璃体腔注射bevacizumab治疗特发性CNV安全有效,但其长期的疗效和安全性评价尚需进行多中心、大样本的临床随机对照研究。

Objective Choroidal neovascularization （CNV） is a main cause inducing blindness in many eye diseases. Bevacizumab,a anti-vascular endothelial growth factor （VEGF） drugs has been used to treat CNV. This study was to evaluate the efficacy and safety of intravitreal bevacizumab injection for idiopathic CNV. Methods Present study was single-center, uncontrolled retrospective clinical study. Forty-five eyes from 43 patients with idiopathic CNV were determined by indirect ophthalmoscope, fundus fluorcscein angiography （FFA） and optic coherence tomography （OCT）. The cases included 7 male （8 eyes） and 36 female patients （37 eyes） with the average age 31.76 ± 10. 03 years old. The course of diseases were from 5 days to 3 years. The subfovea] CNV and juxtafoveal CNV were found in all the patients. 1.25 nag （0. 05 mL） of bevacizumnab was intravitreally injected l -5 times at the 6-week interval. The visual acuity, fundus findings,FFA and central foveal thickness were recorded and analyzed before and after operation. The follow-up time was from 3 months to 12 months. The Human Ethics Committee of the People＇ s Hospital of Peking University approved the study protocol. Written informed consent was obtained from all patients before the initiation of any study medication and study-related procedure. Results The mean baseline logMAR visual acuity of the patients was 0. 66 ± 0. 35. The mean logMA1R visual acuity enhanced to 0. 29 ± 0. 27 after operation （ P 〈 0. 0l ）. The mean central foveal thickness reduced from preoperative 358 ± 103 μm to postoperative 229 ±114 μm （P 〈 0. 01 ）. The fluoreseein leakage from CNV was obviously relieved in 17 eyes and disappeared in 24 eyes following the injection of bevacizumab. The subconjunctiva hemorrhage occurred in 3 eyes, and no other complication was found after injection of bevaeizumab. Conclusion Intravitreal injection of bevacizumnab is a safe and effective approach to the treatment of idiopathic CNV. A multi-center randomized controlled clinical study is needed to evaluate the long-term safety and efficacy of intravitrea] injection of bevaeizumnab for idiopathic CNV.