雷珠单抗联合激光治疗多发性中心性浆液性脉络膜视网膜病变临床观察

Clinical observation of efficacy of intravitreal lucentis injection combined with laser treatment for multiple chronic central serous chorioretinopathy

目的观察雷珠单抗玻璃体注射联合眼底氪激光治疗多发性中心性浆液性脉络膜视网膜病变(CSC)的疗效。设计回顾性病例系列。研究对象北京宣武医院多发性CSC患者13例20眼。方法所有患者术前均行最佳矫正视力(BCVA)、荧光素眼底血管造影(FFA)、频域相干光断层扫描(SD-OCT)检查。对患眼先行雷珠单抗玻璃体注射,4周后行眼底氪激光治疗,观察患眼联合治疗后4、8、12周的BCVA,视网膜下液(SRF)及FFA影像学变化。主要指标BCVA、FFA、SD-OCT。结果雷珠单抗治疗后4周所有患眼的多个渗漏点的神经上皮或色素上皮脱离均显著好转,BCVA显著提高(从0.47±0.24到0.70±0.16,P=0.042)。治疗前中心凹下SRF为(445±134)μm,雷珠单抗治疗4周为(182±101)μm。联合治疗后8周的SRF为(59±11)μm(P=0.004)。治疗前中心凹外SRF为(409±112)μm,雷珠单抗治疗4周后及联合治疗后8周的SRF分别为(142±87)μm、(50±15)μm(P=0.023)。联合治疗后12周的FFA检查显示未见异常渗漏点。结论玻璃体内注射雷珠单抗联合眼底氪激光治疗多发性CSC具有较好的疗效,雷珠单抗治疗能同时对多个渗漏点起作用,促进视网膜神经上皮和色素上皮下液吸收,缩短治疗时间,显著提高视力,降低激光治疗对视网膜的损伤。

Objective To observe the clinical efficacy of intravitreal lucentis injection combined with Laser treatment in the treatment of multiple chronic central serous chorioretinopathy （CSC）. Design Retrospective case series. Participants 20 eyes of 13 patients with multiple CSC were enrolled. Methods All patients were confirmed by best corrected visual acuity （BCVA）, fundus fluorescein anglngraph （FFA） and spectral domain optical coherence tomography （SD-OCT）. All the patients were treated with an intravitreal injection of lucentis, 4 weeks after injection, laser treatment were performed. Patients had follow-up on 4,8,12 weeks after all the treatment. Main Outcome Measures included pre and post treatment changes in BCVA, FFA and subretinal fluid （SRF）. Results 4 weeks after the lueentis injection, the nerve epithelium or pigment epithelium detachment was significantly improved in all eyes. All of the patients BCVA were significantly improved （from 0.47±0.24 to 0.70±0.16, P=0.042）. The SRF was （445±134） μm before treatment, and it was （182± 101） μm after intravitreal lucentis injection treatment 4 weeks. The SRF was （59±11） μm （P=0.004） after 8 weeks combined treatment. The SRF of parafoveal was （409±112） μm before treatment, after 4 weeks lucentis treatment it was （142-±87） μm and the SRF was （50± 15） μm after 8 weeks combined treatment. The FFA showed no abnormal leakage 12 weeks after all treated. Conclusion Intravitreal lucentis injection combined with laser treatment of multiple CSC has curative effect. Intravitreal lucentis injection treatment can work on leakage points, at the same time, promote the retinal neuroepithefium and pigment epithelium under liquid absorption, shorten the treatment time, improve patients＂ BCVA, and reduce the retinal damage by laser treatment.