玻璃体腔重复注射雷珠单抗对脉络膜新生血管患眼脉络膜厚度的影响

Choroidal thickness after intravitreal ranibizumab injections for choroidal neovascularization

目的 观察玻璃体腔重复注射雷珠单抗对脉络膜新生血管（CNV）患眼脉络膜厚度（CT）的影响.方法 前瞻性、开放性无对照研究.临床确诊的渗出型老年性黄斑变性（AMD）患者31例31只眼（AMD组）以及病理性近视CNV患者33例33只眼（病理性近视组）纳入研究.所有患眼行玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml（含雷珠单抗0.5 mg）治疗,之后每一个月随访1次,共随访6个月.AMD组、病理性近视组患眼平均注射次数分别为（4.23±1.33）、（2.27±0.88）次.治疗前及治疗后1、3、6个月,采用频域光相干断层扫描的增强深度成像技术测量患眼中心凹下CT.对比分析治疗前后患眼的CT变化.分析末次随访时CT降低值与注射次数的相关性.结果 治疗后l、3、6个月,AMD组患眼平均CT较治疗前分别降低了（9.68±11.02）、（12.58±11.04）、（13.84±11.67） μm.AMD组患眼治疗后1、3、6个月平均CT与治疗前比较,差异均有统计学意义（t=4.89、6.34、6.60,P＜0.001）.病理性近视组患眼平均CT分别为（81.09±63.20）、（79.52±63.64）、（79.88±62.46） μm,较治疗前分别降低了（2.06±10.92）、（3.64±8.78）、（3.27±7.20）μm.病理性近视组患眼治疗后1个月平均CT与治疗前比较,差异无统计学意义（t=1.08,P=0.287）;治疗后3、6个月平均CT与治疗前比较,差异均有统计学意义（t=2.38、2.61,P=0.024、0.014）.相关性分析结果显示,AMD组、病理性近视组患眼末次随访时CT降低值与注射次数均无相关性（r=0.04、0.30,P=0.815、0.099）.结论 玻璃体腔重复注射雷珠单抗会引起渗出型AMD及病理性近视CNV患眼的CT降低.

Objective To study changes in choroidal thickness（CT） with intravitreal injections of ranibizumab treatment.Methods This is a prospective,uncontrolled,open-label study.A total of 31 eyes of 31 patients diagnosed with wet age-related macular degeneration （AMD） and 33 eyes of 33 patients diagnosed with choroidal neovascularization （CNV） secondary to pathological myopia （PM） were included in the study.All affected eyes were treated with intravitreal ranibizumab 0.05 ml （10 mg/ml） and followed up monthly until 6 months.Enhanced depth imaging on Cirrus spectral-domain optical coherence tomography was used to measure the CT.The initial CT was compared with the data at 1,3 and 6 month after treatment,and the correlation between of the decrease of CT at the 6 month and the number of injection times was analyzed.Results In AMD group,the average CT respectively decreased by （9.68 ± 11.02）,（12.58±11.04）,（13.84± 11.67） μm at 1,3 and 6 month,and the differences were significant（t=4.89,6.34,6.60;P＜0.001）.In PM group,the average CT respectively decreased by （2.06± 10.92）,（3.64± 8.78）,（3.27±7.20）μm at 1,3 and 6 month.The difference at 1 month was not significant （t=l.08,P=0.287）.While after 3 months and 6 months,the differences were significant （t =2.38,2.61 ; P =0.024,0.014）.The injection times were not correlated with the CT decreases at 6 month in both groups（r=0.04,0.30;P=0.815,0.099）.Conclusion Intravitreal injections of ranibizumab can induce choroidal thickness reduction for wet age-related macular degeneration and choroidal neovascularization secondary to pathologic myopia.