光动力疗法联合玻璃体腔注射Avastin治疗脉络膜新生血管疗效观察

Clinical observation of photodynamic therapy combined with vitreous cavity injection of Avastin treatment for choroidal neovascularization in high myopia

目的观察光动力疗法（PDT）联合玻璃体腔注射Avastin治疗高度近视脉络膜新生血管（CNV）的临床疗效。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）、光相干断层扫描（OCT）检查确诊为高度近视脉络膜新生血管的患者16例19只眼纳入治疗。患者中男8例10只眼，女8例9只眼。年龄23～81岁，平均56岁。病程0．5～10个月，平均3．4个月。矫正视力0．01—0．5。平均眼压（14．67±2．65）mmHg（1mmHg=0．133kPa）。入选病例全部或部分CNV在距黄斑中心凹500μm范围内，PDT治疗按维替泊芬PDT治疗（VIP）研究组的方法进行。3d后在表面麻醉下给予1．5mgAvastin玻璃体腔注射。治疗后1，3，6个月随访。结果末次随访时，矫正视力0．01—1．2，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31．57％；提高2～4行者9只眼，占47．37％；稳定或波动在1行以内者3只眼，占15．78％；1只眼较前出现轻度视力下降。治疗后平均眼压（15．21±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检查18只眼荧光素渗漏消退、明显减弱或不同程度减弱，OCT检查所有患者CNV周围视网膜水肿消失。结论PDT联合玻璃体腔注射Avastin治疗高度近视脉络膜新生血管疗效较好。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 investigate the photodynamic therapy （PDT） combined with vitreous cavity injection of Avastin treatment for choroidal high myopia in neovascularization （CNV）. Clinical Observation. Methods A total of 19 eyes of 16 patients with high myopia choroidal neovascularization （CNV） ,which was diagnosed by examination of visual acuity, intraocular pressure, ocular ftmdus, fundus color photography, fundus fluorescein angiography （FFA）, and optic coherence tomography （OCT）, were underwent PDT combined with intravitreal injection of Bevacizumab. The patients, 8 males （ 15 eyes） and 8 females （9 eyes）, aged from 23 to 81 years,with the average of 56 years. The best corrected visual acuity was 0.01-0.5. Selected cases of CNV were treated in whole or in part from the macular center in the framework ofAu 500μ m ,PDT treatment in accordance with the PDT verteporfin therapy （VIP） Study Group methods. Intravitreal injection with 1.5mg Avastin was performed after three days under surface anesthesia. Follow-up time was 1 month, 3 and 6 months after the treatment. Results At last visit,the best corrected visual acuity was 0.01,-0.2. The differences were statistically significant compared with before. The BCVA improved four or more lines in 6 eyes （31.57% ）, improved two to four lines in 9 eyes （47.37%）, stabilized （±1 line or no change） in 3 eyes （15.78%）. Visual acuity of one eye decreased mildly compared to before treatment. The average intraocular pressure was （15.21± 2.41 ） mmHg after surgery,and the differences was not statistically significant compared with before （P 〉 0.05 ）. FFA examination in 18 eyes fluorescein leakage subsided significantly reduced or diminished in varying degrees, OCT examination of all patients with retinal edema surrounding the disappearance of CNV. Conelusions Combining treatment with PDT and intravitreal injection of Avastin is safe and effective for CNV which caused by high myopia. It has significant improvement in BCVA, leakage of CNV and retinal edema.