玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管疗效观察

Pathological myopia combined with choroidal neovascularization treated by intravitreal injection of ranibizumab

目的观察玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效及安全性。方法回顾性分析18例18眼病理性近视患者的临床资料。玻璃体内注射雷珠单抗0.5 mg(0.05 mL),术后每个月随访时行最佳矫正视力(best corrected visual acuity,BCVA)、眼底彩照、光学相干断层扫描(optical coherence tomography,OCT)检查,术后1个月、3个月、6个月随访时行眼底荧光血管造影(fluorescence fundus angiography,FFA)检查。随访过程中发现CNV部分闭合或持续渗漏者则再次予以玻璃体内注射雷珠单抗。比较治疗前后BCVA、OCT、眼底彩照及FFA检查结果 ,观察其临床疗效及安全性。结果术后1个月、3个月、6个月随访时,BCVA均较术前明显提高(F=11.354,P<0.05);黄斑中心凹厚度均较术前明显降低(F=4.242,P<0.05)。术后6个月随访时,16眼视力提高2行以上,2眼视力稳定;眼底彩照示所有患眼黄斑区出血吸收,FFA检查示14眼CNV完全闭合,4眼大部分闭合。玻璃体内注射雷珠单抗平均次数为2.56次,其中3眼行1次,8眼行2次,5眼行3次,2眼行4次。随访期间所有患者均未出现眼部及全身并发症。结论玻璃体内注射雷珠单抗治疗病理性近视合并CNV是安全有效的。

Objective To evaluate the effects and safety of pathologic myopia with choroidal neovascularization （CNV） treated by intravitreal injection of ranibizum- ab. Methods The medical records of 18 patients with pathological myopia and CNV were retrospectively reviewed. The patients was followed up monthly after intravitreal injection of ranibizumab 0.5 mg（0.05 mL） ,best corrected visual acuity, fundus exami- nation and OCT were observed. FFA was performed at 1 month,3 months,6 months af- ter operation. During follow-up, if part of a closed or continuous leakage of CNV was found,intravitreal injection of Ranibizumab was done again. The results of BCVA,OCT, FFA and fundus examination before and after treatment were compared, and the clinical efficacy and safety were observed. Results At 1 m0nth,3 months,5 months after op- eration,best corrected visual acuity in all eyes was improved compared with pre-opera- tion, and the difference was significant （F = 11. 354 ,P 〈 0.05 ） ; Central macular thickness in all eyes were reduced, and the difference was significant （ F = 4. 242, P 〈 0.05 ）. At 6 months after operation,visual acuity of 15 eyes（ 88.89% ） increased more than 2 lines, visual acuity of 2 eyes（ ll. ll% ） remained stable. Fundus photograph showed hemor- rhage absorption of macular region in all eyes. FFA showed CNV for 14 eyes（77.78% ）completely closed, and 4 eyes （ 22.22% ） mostly closed. The average number of intravitreal injection of Ranibizumab was 2. 55,in which 3 eyes for 1 time,10 eyes for 2 times,5 eyes for 3 times,and 2 eyes for 4 times. During follow-up,ocular and systemic complication was not found in all patients. Conclusion Treatment of pathologic myopia with CNV by intravit- real injection of ranibizumab is safe and effective.