贝伐单抗和雷珠单抗玻璃体腔注射治疗病理性近视脉络膜新生血管的疗效对比观察

Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization

目的 对比观察贝伐单抗和雷珠单抗玻璃体腔注射治疗病理性近视（PM）继发脉络膜新生血管（CNV）的疗效.方法 回顾性病例研究.临床检查确诊的PM-CNV患者79例79只眼纳入研究.其中,男性26例26只眼,女性53例53只眼;平均年龄（30.77±5.53）岁.均行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜、眼底彩色照相、荧光素眼底血管造影、光相干断层扫描（OCT）检查.采用标准对数视力表由同一名验光师行BCVA检查,记录时换算为最小分辨角对数（logMAR）视力.采用美国蔡司公司Cirrus HD-OCT仪行OCT检查,测量患眼黄斑中心视网膜厚度（CMT）.依据接受治疗情况将患眼分为贝伐单抗治疗组、雷珠单抗治疗组,分别为38、41只眼.两组患眼平均logMAR BCVA（t=-0.467）、眼压值（t=-1.983）、CMT值（t=1.293）比较,差异均无统计学意义（P=0.642、0.051、0.200）.贝伐单抗治疗组、雷珠单抗治疗组患眼玻璃体腔分别注射贝伐单抗0.05 ml（含贝伐单抗1.25 mg）、雷珠单抗0.05 ml（含雷珠单抗0.50 mg）.对比观察两组患眼治疗后1、7d,1个月眼压变化情况;1、3、6、12、24个月logMARBCVA、CMT变化情况以及与药物和治疗方式相关的眼部和全身不良反应发生情况.结果 治疗后1、7d,1个月,两组患眼平均眼压值比较,差异无统计学意义（t=-1.349、0.07、1.382,P＞0.05）.治疗后1、3、6、12、24个月,贝伐单抗治疗组、雷珠单抗治疗组患眼平均logMAR BCVA均较治疗前提高,差异有统计学意义（F=132.374,P＜0.01）;两组患眼之间治疗后不同时间点平均logMARBCVA比较,差异均无统计学意义（F=0.095,P=0.759）.两组患眼平均CMT值均较治疗前下降,差异有统计学意义（F=132.374,P＜0.01）;两组患眼之间治疗后不同时间点平均CMT值比较,差异均无统计学意义（F=0.332,P=0.566）.随访期间均未发生视网膜脱离、眼内炎、白内障及持续性眼压升高等与药物、注射相关的严重眼部和全身不良事件.出现结膜下出血7只眼;患者诉眼前黑影飘动11只眼,未干预自行吸收.结论 贝伐单抗和雷珠单抗玻璃体腔注射治疗PM-CNV的治疗效果相似,均可提高患眼BCVA,降低CMT.

Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization （PM-CNV）.Methods It is a retrospective case study.Seventy-nine patients （79 eyes） with PM-CNV were enrolled in this study.There were 26 males （26 eyes） and 53 females （53 eyes）,with the mean age of （30.77 ± 5.53） years.The best corrected visual acuity （BCVA）,intraocular pressure,slit lamp microscope,fundus color photography,fundus fluorescein angiography,and optical coherence tomography （OCT） were performed.BCVA was recorded as logarithm of the minimum angle of resolution （logMAR）.The central retinal thickness （CMT） was measured by OCT （Cirrus HDOCT）.The eyes were divided into bevacizumab treatment group （38 eyes） and ranibizumab treatment group （41 eyes）.There was no difference of the mean logMAR BCVA,intraocular pressure and CMT between two groups （t=-0.467,-1.983,1.293;P=0.642,0.051,0.200）.The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml （1.25 mg）,and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml （0.5 rag）.Times of injection between two groups were compared.The changes of intraocular pressure were observed at 1,7 days and 1 month after treatment.The changes of logMAR BCVA and CMT at 1,3,6,12 and 24 months after treatment and systemic adverse reactions occur were compared.Results At the 1,3,6,12 and 24 months after treatment,the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment （F=132.374,P〈0.01）.There was no significant difference in the mean logMAR BCVA at different time points between the two groups （F=0.095,P=0.759）.The mean CMT of the two groups was lower than that before treatment （F=151.653,P〈0.01）.There was no significant difference in the mean CMT between the two groups （F=0.332,P=0.566）.No retinal detachment,endophthalmitis,cataract and persistent high intraocular pressure were associated with drug,injection-related eye and systemic adverse events during follow-up.Seven eyes had conjunctiva bleeding after treatment,11 patients （11 eyes） complained of shadow floaters after treatment.Conclusion Intravitreal injection ofbevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.