抗血管内皮生长因子治疗息肉状脉络膜血管病变的临床观察

Clinical observation on treatment of polyiform choroidal vasculopathy with anti-vascular endothelial growth factors

目的观察玻璃体腔注射抗血管内皮生长因子治疗息肉状脉络膜血管病变的临床效果。方法选取我院2010年4月~2012年4月收治的22例(23眼)息肉状脉络膜血管病变患者作为研究对象,均接受玻璃体腔注射抗血管内皮生长因子治疗方案,于治疗完毕后随访3年,观察记录患眼矫正视力的变化情况,并行光学相干断层扫描(OCT)及荧光素血管造影检查(FFA),评估治疗效果。结果本组22例(23眼)中,5眼术后注射部位结膜下端少量出血,在短期内均自行消退;术后无一眼出现严重并发症;治疗1 w^36个月后,患眼视力有所降低,但与治疗前对比无显著差异(P>0.05)。术后1 w^24个月,患眼眼底中心视网膜厚度(CRT)和黄斑中心凹厚度(CFT)呈持续下降趋势;术后12、24、36个月CRT与治疗前对比有统计学差异(P<0.05),术后24个月CFT与治疗前对比差异显著(P<0.05)。结论采用玻璃体腔注射抗血管内皮生长因子治疗息肉状脉络膜血管病变,对患眼视力无明显不良影响,且有助于患眼黄斑区及中心凹的恢复,治疗有效性高,值得推广。

Objective To observe the clinical effects of intravitreal injection with anti-vascular endothelial growth factors on polyiform choroidal vasculopathy. Methods 22 cases （23 eyes） of polyiform choroidal vasculopathy admitted between April 2010 and April 2012 were selected as the research objects. All patients received the treatment plan of intravitreal injection with anti-vascular endothelial growth factors. Follow-up had been made for three years after the treatment. Observation and recording were made in the changes of corrected vision. The optical coherence tomography （OCT） and fluorescein fundus angiography （FFA） were performed, and the therapeutic effects were evaluated. Results Among the 22 cases （25 eyes）, there were 5 eyes with little bleeding in lower conjunctiva of injection site after the operation, which were relieved spontaneously. There was no case of complications occurred after the operation. After a week to 36 months of treatment, the visual acuity of patients decreased, but compared with that before the treatment, the difference was not significant （P 〉 0.05）. A week to 24 months after the operation, patients＇ center retinal thickness （CRT） and central foveal thickness （CYF） showed a trend of continuous decline. 12, 24 and 36 months after the operation, there was Significant difference between the CRT before and after the treatment （P 〈 0.05）. The difference between the CF＇F before and 24 months after the treatment was significant（P 〈 0.05）. Conclusion Intravitreal injection with anti-vascular endothelial growth factors for the treatment of polyiform choroidal vasculopathy has no significant harmful effects on patients＇ eyesight. Furthermore, it is helpful to the recovery of macular region and fovea centralis and has high efficacy, which is worthy of promotion.