抗血管内皮生长因子单克隆抗体ranibizumab治疗渗出型老年性黄斑变性方案的探讨

Intravitreal Ranibizumab regimens for exudative aged-related macular degeneration

目的观察抗血管内皮生长因子（VEGF）单克隆抗体ranibizumab（商品名Lucentis）玻璃体腔注射治疗渗出型老年性黄斑变性（AMD）的临床疗效。方法回顾分析临床确诊为渗出型AMD并接受玻璃体腔注射ranibizumab治疗的46例患者52只眼的临床资料。患者均进行了糖尿病早期治疗研究（ETDRs）视力表、检眼镜、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）以及光相干断层扫描（OCT）检查。确诊渗出型AMD后，采用10mg／ml的ranibizumab 0．05ml玻璃体腔注射治疗。每一个月注射1次，连续注射3次，随后根据每一个月的检查情况决定是否进行再次注射。52只眼共注射214次，每一只眼注射2～6次，平均注射4．12次。随访观察12个月。对比分析治疗前后视力、视网膜厚度及脉络膜新生血管（CNV）病灶渗漏变化情况。结果治疗后12个月，52只眼ETDRS视力表的平均字母数是37．8个，较治疗前提高11.4个（t=3．475，P％O．01）。CNV病灶渗漏完全停止11只眼，占21．2％；渗漏范围明显减少34只眼，占65．4％；渗漏无明显变化者4只眼，占7．7％；病灶增大2只眼，占3．8％；新病灶出现1只眼，占1．9％。OCT检查显示，视网膜厚度平均值为187．50μm，较治疗前下降122．80μm（t=0．593，P〈0．01）。结论按治疗方案进行的ranibizumab玻璃体腔注射治疗渗出型AMD可使视力提高、视网膜水肿明显减轻、CNV病灶渗漏停止或减少。

Objective To observe the clinical efficacy of intravitreal Ranibizumab on exudative agerelated macular degeneration （AMD）. Methods The clinical data of 46 patients （52 eyes）with exudative AMD were analyzed retrospectively. All patients were diagnosed by examination of early treatment of diabetic retinopathy study （ETDRS） charts, color fundus photograph, fluorescein angiography （FFA） or indocyanine green angiography（ICGA）and optical coherence tomography（OCT）. They received intravitreal injection of 0. 05 ml （10 mg/ml） Ranibizumab, once per month for 3 months. Further injection may be required if the monthly follow-up indicated. A total of 52 eyes received 214 times of injections, each eye received 2-6 injections （mean 4. 12）. The Follow up duration was 12 months. Vision acuity, fovea thickness and CNV leakage before and after treatment were analyzed. Results At the 12th month after treatment, the mean letter of ETDRS charts was 37.80 （11.40 letters more that pre-treatment index, P〈0.01）. FFA and （or） ICGA showed complete closures choroidal neovascularization （CNV） in 11 eyes（21.20%）, partial closures in 34 eyes （65.40%）,no change in four eyes （7. 70%）,lesion growth in two eyes（3.80%）and new lesion in one eye （1. 90%）. OCT indicated the average of fovea thickness was 187.5μm （122.80μm less than the pre-treatment index, P〈0.01）. Conclusion Intravitreal injection of Ranibizumab for exudative AMD according to this therapeutic schedule was well tolerated,with an improvement in visual acuity,FFA or ICGA and OCT.