PDT联合玻璃体内注射雷珠单抗治疗孤立性脉络膜血管瘤

Effect of photodynamic therapy combined with intravitreal ranibizumab injection on circum scribed choroidal hemangioma

目的:观察光动力(photodynamic therapy,PDT)联合玻璃体腔内注射雷珠单抗治疗孤立性脉络膜血管瘤(circumscribed choroidal hemangioma,CCH)的临床疗效。方法:临床确诊为CCH患者6例6眼纳入研究。治疗前光学相干断层扫描(OCT)检查结果显示均有黄斑区视网膜神经上皮脱离和黄斑水肿。所有患者行PDT 48h后再行玻璃体内注射雷珠单抗0.5mg(0.05mL)。分别在治疗后1、3、6mo进行最佳矫正视力、眼底照相、视网膜血管造影(FFA)、脉络膜血管造影(ICGA)、眼部B超、OCT检查。结果:治疗后随访4~10mo,治疗眼视力均提高,平均视力提高7行,最佳矫正视力达到0.5~1.0,ICGA检查:轻微点状弱荧光或荧光消失。超声波检查:瘤体面积明显缩小或消失。OCT检查显示黄斑部浆液性视网膜脱离平复,黄斑水肿消失,视网膜结构清晰。平均随访6mo未见肿瘤复发。结论:PDT治疗使脉络膜血管瘤明显萎缩,雷珠单抗玻璃体注射促进网膜下积液的吸收,可短期内提高患眼视力。二者联合治疗,各发挥其优点,缩短病程,降低了多次治疗费用。

AIM：To investigate the effect of photodynamic therapy（PDT） combined with intravitreal injection of ranibizumab on circumscribed choroidal hemangioma（CCH）.METHODS：A retrospective study was performed for 6eyes（6 cases） diagnosed as CCH.Before treatment,OCT examination showed macular cystoid edema and retinal neurepithelium layer detachment in all patients.All patients underwent photodynamic therapy,then intravitreal injection of ranibizumab 0.5mg（0.05mL）were administered at 48 h after PDT.The best corrected visual acuity（BCVA）,examination of the ocular fundus,fundus photography,fluorescence fundus angiography（FFA）,indocyanine green angiography（ICGA）,eye B ultrasonic and optical coherence tomography（OCT） were performed respectively at 1,3 and 6mo after treatment.· RESULTS：The patients were followed up for 4 to 10 mo,the final vision of follow-up increased than before,it was raised 7 lines.The images of ICGA revealed hypofluorescence or no leakage in focal area.Eye B ultrasonic showed that hemangioma shrunk or faded.The images of ICGA revealed macular region retinal reattached well and edema disappeared completely.Mean flow-up was 6mo postoperative.There had no evidence of recurrence.CONCLUSION：For CCH patients,hemangioma got smaller obviously by PDT.Intravitreal ranibizumab injection promote effusion absorption under the retina.Combining use of the two therapies could improve visual acuity in a short-term.