抗血管内皮生长因子药物玻璃体腔注射以及联合光动力疗法治疗渗出型老年性黄斑变性疗效观察

Combination treatments of photodynamic therapy and intravitreal anti-vascular endothelial growth factor drugs for exudative age-related macular degeneration

目的观察抗血管内皮生长因子（VEGF）药物ranibizumzb玻璃体腔注射与光动力疗法（PDT）联合ranibizumzb玻璃体腔注射治疗渗出型老年性黄斑变性（AMD）的疗效。方法渗出型AMD患者30例30只眼，分为ranibizumzb玻璃体腔注射治疗组与PDT联合ranibizumzb玻璃体腔注射治疗组，每组各15例15只眼。治疗及随访时间6～17个月，平均治疗随访时间12．5个月。其中，ranibizumzb玻璃体腔注射治疗组玻璃体腔注射ranibizumzb0．5mg，每一个月1次，连续注射12个月；自第一次治疗后每一个月随访1次。PDT联合ranibizumzb玻璃体腔注射治疗组于PDT后24h内玻璃体腔注射相同剂量ranibizumzb，第2、3个月分别再行相同剂量ranibizumzb玻璃体腔注射；于3次治疗后每一个月随访1次，随访期内出现重复治疗指征则重复注射1次。Ranibizumzb玻璃体腔注射平均次数（3．7±1．0）次。对比观察两组患者治疗前后最佳矫正视力（BCVA）、光相干断层扫描（OCT）、荧光素眼底血管造影（FFA）和MP-1微视野计检查结果、ranibizumzb玻璃体腔注射平均次数及并发症。结果治疗后第1、3、6、12个月，ranibizumzb玻璃体腔注射治疗组患眼黄斑区平均光敏感度（MS）平均提高值分别为1．9、3．8、5．0、5．5dB，PDT联合ranibizumzb玻璃体腔注射治疗组患眼MS平均提高值为2．0、4．2、3．7、4．8dB。两组MS提高值比较，差异无统计学意义（t=-0．791、-0．171、1．339、0．785；P=0．943、0．865、0．173、0．898）。BCVA、OCT改变情况比较，差异无统计学意义（P〉0．05）。MS与BCVA之间为正相关（r=0．660，P=0．037）。随访期间未发现眼内感染、视网膜色素上皮撕裂和玻璃体积血等并发症。结论Ranibizumzb玻璃体腔注射与PDT联合ranibizumzb玻璃体腔注射均为治疗渗出型AMD的有效方法，但后者能有效减少ranibizumzb玻璃体腔重复注射的次数。

Objective To observe the efficacy of intravitreal injection of ranibizumab （Lucentis） and combination treatments of photodynamic therapy （PDT） and intravitreal injection of ranibizumab for exudative age-related macular degeneration （eAMD）. Methods Thirty eyes from 30 patients with eAMD were enrolled in this study. Fifteen eyes were treated with intravitreal injection of ranibizumab （ranibizumab group）, while 15 eyes were treated with combination treatments of PDT and intravitreal injection of ranibizumab （combination group）. The follow-up ranged from 6 to 17 months with a mean of 12.5 months. The patients in ranibizumab group received intravitreal injection of ranibizumab （0.5 mg） once a month for 12 consecutive months. Follow-up visits were performed monthly after the first injection. The patients in the combination group received intravitreal injection of ranibizumab （0.5 mg） within 24 hours after PDT. Then the same dose of intravitreal injection was given the 2nd and 3rd months. They were examined on follow-up visits monthly after the 3rd injection. Injections were repeated if necessary during follow-up period. The mean number of repetitive intravitreal injections of ranibizumab was （3.7±1.0） times/eye. Changes in best corrected visual acuity （BCVA）, results of optic coherence tomography （OCT）, fundus fluorescein angiography （FFA） and MP-1, injection times and complications were observed. Results The 1st, 3rd, 6th and 12th month after treatment, the average improvement value in mean light sensitivity （MS） were 1.9, 3.8, 5.0 and 5.5 dB in ranibizumab group; 2.0, 4.2, 3.7 and 4.8 dB in combination group respectively. The difference between two groups was not statistically significant （P）0.05）. The differences of improvement in BCVA and OCT between two groups also were not statistically significant （P〉0.05）. The MS has positive relationship with BCVA （r = 0. 660, P〈0.05）. No complications such as endophthalmitis, retinal pigment epithelial tear or vitreous hemorrhage were observed during the follow-up period. Conelusiuns Both intravitreal injection of ranibizumab and combination treatments of PDT and intravitreal injection of ranibizumab are effective for eAMD. Combination of PDT and ranihizumab therapy decreases the frequency of retreatment.