眼底血管样条纹并发脉络膜新生血管的临床特征及联合治疗

Clinical characteristics and combined treatment for choroidal neovascularization secondary to angioid streaks

目的 分析眼底血管样条纹（AS）并发CNV的临床特征,探讨光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗AS合并黄斑病变的临床疗效及安全性.方法 回顾性系列病例研究.分析21例（42眼）AS的临床资料,包括BCVA、眼底表现、FFA、ICGA以及OCT.其中18例（22眼）合并黄斑CNV,先采用PDT治疗,3d内玻璃体腔注射雷珠单抗,治疗后定期随访,至少随访12个月.随访时如发现视力下降、黄斑区出现新病灶、视网膜下或层间积液、CNV活动性病变,则重复玻璃体腔注射.数据采用独立样本t检验或配对样本t检验进行分析.结果 本组21例患者均双眼发病,仅5例（24％）合并全身病变,男性为主（76％）,其中18例（86％）继发黄斑CNV,BCVA显著低于病变未侵及黄斑者.联合治疗的22眼末次随访时BCVA较治疗前提高10.4个字母;OCT示治疗后黄斑区视网膜厚度从基线的（338.4±55.2） μm降至（212.6±36.2） μm;FFA（ICGA）显示15眼（68％）CNV完全闭合,渗漏消失,5眼呈瘢痕染色.所有患者接受1次PDT,平均玻璃体腔注射次数3.2次.1例PDT后出现黄斑区视网膜下出血,行玻璃体腔注射雷珠单抗后出血吸收,5例发生一过性眼压升高,4例出现结膜下出血,均完全恢复,无其他明显眼部及全身不良反应.结论 眼底AS具有特殊的眼底表现,FFA （ICGA）有助于明确诊断,相当比例的患者可继发黄斑部CNV.PDT联合玻璃体腔注射雷珠单抗能有效控制AS合并黄斑病变的病情进展,显著改善患者视功能,减少CNV渗漏,且不良反应少.

Objective To investigate the clinical characteristics and evaluate photodynamic therapy treatment combined with intravitreal injection of Lucentis for choroidal neovascularization secondary to angioid streaks.Methods This was an interventional retrospective analysis of 21 patients （42 eyes）.For clinical data,best corrected visual acuity （BCVA）,fundus appearance,fundus fluorescence angiography （FFA）,indocyanine green angiography （ICGA） and optical coherence tomography （OCT） were assessed.Twenty-two eyes of 18 patients with macular choroidal neovascularizaiton （CNV） were treated first with photodynamic therapy （PDT） and then with an intravitreal injection of Lucentis.The patients were followed up for at least 12 months.Another injection was given if one of the following appeared：decreased visual acuity,new macular lesions,subretinal or intraretinal fluid,or CNV leakage.Data were analyzed using an independent-samples t test or a paired-samples t test.Results Both eyes of all 21 patients were involved.Only 5 patients （24%） had complications with hologathy.Males were more affected （76%）.Of all the patients,18 cases （86%） were diagnosed with CNV secondary to AS.BCVA was much worse in eyes with CNV.At the final follow-up after the combination treatment,BCVA had improved 10.4 characters.OCT showed macular retinal thickness decreased from 338.4±55.2 μm at baseline to 212.6±36.2 μm.FFA （ICGA） showed CNV leakage in 15 eyes （68%） had disappeared completely,and 5 eyes had scar staining.All patients received 1 treatment of PDT and a mean 3.2 intravitreal injections.Macular subretinal hemorrhage presented in 1 patient after PDT,but was absorbed completely after intravitreal injection.Five patients presented with transient elevated intraocular pressure and 4 patients had subconjunctival hemorrhage but all recovered quickly.No other ocular or adverse reactions occurred.Conclusion Angioid streaks present a special fundus appearance,and FFA（ICGA） is valuable in the diagnosis.A considerable proportion of patients are affected with CNV secondary to AS.PDT treatment combined with intravitreal injection of Lucentis is effective in preventing disease progression,improving visual acuity,and reducing CNV leakage.Adverse reactions are mild.