息肉样脉络膜血管病变经光动力学疗法联合抗血管内皮生长因子治疗后并发眼底出血的预后分析

Prognosis of fundus hemorrhage after PDT combined anti-VEGF treatment in polypoidal choroidal vasculopathy patients

目的：观察特发性息肉样脉络膜血管病变（polypoidal choroidal vasculopathy,PCV）患者经眼底光动力学（PDT）疗法联合抗血管内皮生长因子（anti-VEGF）治疗后合并视网膜或玻璃体出血的眼底特征和治疗效果。方法：回顾性分析2010年3月—2015年3月临床确诊的PCV患者临床资料,其中5例（5只眼）经PDT联合抗VEGF药物玻璃体腔注射治疗后出现眼底或玻璃体出血,随访3-24个月复查患者最佳矫正视力及眼底造影检查结果。结果：2例患者在PDT联合抗VEGF治疗后1周-1个月内出现视网膜下出血;1例患者在抗VEGF玻璃体注射后1周内出现玻璃体出血;2例患者在第2次PDT治疗后1个月出现视网膜下出血。4例患者经保守治疗后眼底出血大部分吸收,视力平均提高到0.2;1例玻璃体出血患者行玻璃体切割术,术后视力仅恢复到眼前手动。结论：PCV患者行PDT联合抗VEGF玻璃体腔注射治疗存在眼底或玻璃体出血风险,其机制可能与治疗后血流动力学改变及病灶周围其他血管脆性增加有关。

Objective： To observe the retinal images and therapic results of fundus hemorrhage after PDT combined anti-VEGF treatment in polypoidal choroidal vasculopathy patients. Methods.. Retrospective analysis were used to analyze the clinic history and signs of 5 cases with diagnosed PCV patients which fundus hemorrhage were found after PDT combined anti- VEGF therapy between March 2010 to March 2015. Medical examination such as visual acuity, angiography were also involved during 3-24 monthes. Results.. Among 5 partients, 2 patients suffered from subretinal hemorrhage between 1 week to 1 month after combination therapy; 1 patients suffered from vitreous hemorrhage in 1 week after anti-VEGF injection; 2 patients suffered subretinal hemorrhage within i month after the second PDT therapy. 4 patients of above was treated successfully by medical treatment and most of the hemorrhage was absorbed and their visual acuity were rescued to 0. 2 on average; last patient with huge vitreous hemorrhage was received pars plana vitrectomy surgery for hemorrhage treatment. Conclusions： Hemorrhage risks were possible in combination therapy using PDT and anti-VEGF to PCV patients. The mechanism may associated to changes of hemodynamics after therapy or blood vessel brittleness increases in lesion area, which needs further research to clarify.