光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变

Macular visual field changes after combined photodynamic therapy and intravitreal injection of ranibizumab for neovacular age-related macular degeneration

目的评价光动力疗法(photodynamic therapy,PDT)联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性(agerelated macular degeneration AMD)后患者黄斑区中心视野的变化情况。方法本研究纳入湿性AMD患者26例(28眼),每例患者予以1次维替泊芬联合PDT后3 d再给予玻璃体内注射雷珠单抗治疗,然后根据患者治疗后1个月、3个月、6个月的最佳矫正视力(best corrected visual acuity,BCVA)、Humphrey 10-2中心视野检查、黄斑中心凹厚度(central foveal thickness,CFT)、眼底荧光血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)的渗漏情况决定是否需要再次玻璃体内注射雷珠单抗。结果联合治疗后1个月、3个月、6个月,湿性AMD患者的BCVA明显提高,分别为0.22±0.07、0.26±0.07、0.24±0.08(P=0.029、0.004、0.015),而治疗前BCVA为0.12±0.09;CFT显著降低,分别为(264.09±28.40)μm、(273.45±24.89)μm、(286.54±26.39)μm(均为P=0.000),而治疗前CFT为(458.27±27.38)μm;中心视野10°范围内的平均敏感度(mean sensitivity,MS)增加了,分别为(24.33±3.20)dB、(24.54±3.25)dB、(26.89±3.46)dB(P=0.015、0.010、0.000),而治疗前的MS为(20.25±3.12)dB;4°范围内MS增加了,分别为(23.66±4.23)dB、(23.40±4.49)dB、(25.93±4.43)dB(P=0.024、0.034、0.001),而治疗前4°范围内MS是(19.49±4.66)dB;视野平均缺损(mean deviation,MD)降低了,分别为(-7.60±3.24)dB、(-7.72±3.51)dB、(-6.29±3.21)dB(P=0.008、0.010、0.001),而治疗前MD为(-11.98±3.18)dB。模式标准差增加了,分别是5.44±1.53、5.78±1.82、6.88±1.65(P=0.013、0.004、0.000),而治疗前模式标准差为3.34±1.04。所有的数据均提示黄斑区的功能有好转。此外,BCVA和CFT(r=-0.297,P=0.005)、CFT和中心视野10°范围内的MS(r=-0.385,P=0.000)、CFT和视野的MD(r=-0.193,P=0.033)两两之间存在一定的负相关关系。结论黄斑区中心Humphrey视野指数的改变可用于评估PDT联合玻璃体内注射雷珠单抗治疗湿性AMD后患者视功能的改变。

Objective To evaluate the macular visual field changes in pa- tients with neovascular age-related macuiar degeneration （AMD） after combined photodynamic therapy（PDT） and intravitreal injection of ranibizumab. Methods Twenty-eight eyes of 26 patients with neovascular AMD were recruited in this pro- spective,interventional study. Each patient was treated with one session of PDT and one intravitreal injection of ranibizumab 3 days later. Retreatment with intravitreal injection of ranibizumab was performed according to predefmed criteria. Best cor- rected visual acuity（ BCVA）, 10-2 Humphrey visual field testing, central foveal thick- ness（CFT）, leakage on fundus fluorescence angiography （FFA） and indocyanine green angiography（ICGA） were compared between baseline and 1 month,3 months and 6 months after the combined treatment. Results Compared with before treat- ment（ BCVA：0.12 ±0.09） ,BCVA was significantly improved at 1 months,3 months and 6 months after treatment, which were 0.22 ± 0.07 （P = 0.029 ）, 0.26 ± 0.07 （ P = 0.004） and 0.24± 0.08 （P = 0.015 ）, respectively. Compared with before treatment （458.27 ± 27.38）μm, Cft was significantly reduced at 1 month,3 months and 6 months after treatment, which were （ 264.09 ± 28.40 ） txm （ P = 0. 000 ）, （ 273.45 ± 24. 89） μm（P =0.000） and （286.54 ±26.39） μm（P =0.000） ,respectively. Compared with before treatment（ 20.25 ± 3.12 ） dB, visual field parameters 10° MS was signifi- cantly improved at 1 month, 3 months and 6 months after treatment, which were （24. 33 ±3.20） dB（P =0.015）, （24.54 ±3.25） dB（P =0.010） and （26.89 ± 3.46）dB （P = 0.000 ）, respectively. Compared with before treatment （ 19.49 ± 4.66 ）dB, visual field parameters 4~ MS was significantly improved at 1 month, 3 months and 6 months after treatment,which were （23.66 ± 4.23 ） dB （P = 0.024 ）, （ 23.40 ± 4.49 ） dB（P = 0.034） and （ 25.93 ± 4.43 ） dB （P = 0. 001 ）, respectively. Compared with be- fore treatment （ - 11.98 ± 3. 18 ） dB, MD was significantly improved at 1 month, 3 months and 6 months after treatment, which were （ - 7.60 ± 3.24 ） dB （P = 0. 008 ）, （ - 7.72 ± 3.51 ） dB （ P = 0. 010 ） and （ - 6.29 ± 3.21 ） dB （ P = 0. 001 ）, respectively. And compared with before treatment（3.34 ± 1.04 ）, PSD was significantly improved at 1 month,3 months and 6 months after treatment, which were 5.44 ± 1.53 （P = 0. 013） ,5.78 ± 1.82（P =0.004） ,and 6.88 ± 1.65（P =0.000） ,respectively. There was modest negative correlation between BCVA and CFr （ r = - 0. 297, P = 0. 005 ）, CFT and 10°MS（r= -0.385 ,P=0.000） ,cvr and MD（r= -0. 193 ,P =0.033）. Conclusion Macular visual field improvement can be achieved by combined PDT and in- travitreal injection of ranibizumab. Central macular visual field may be useful in eval- uating treatment efficacy in neovascuiar AMD patients.