抗VEGF药物玻璃体内注射治疗视网膜血管样条纹继发脉络膜新生血管的远期观察

Long-term outcomes of intravitreal injection of antiVEGF medication in the treatment of choroidal neovascularization secondary to angioid streaks

目的探讨视网膜血管样条纹继发脉络膜新生血管(choroidal neovascularization,CNV)抗VEGF治疗的远期疗效。方法回顾分析接受玻璃体内注射抗VEGF药物的视网膜血管样条纹继发CNV患者,观察至少3 a后患者视力改善情况、视网膜及脉络膜活动性病灶消退情况等指标。结果纳入分析的21例(30眼)患者中,眼内注射次数6~18(10.0±2.4)次。随访36~54(39.5±2.2)个月。患者首次接受治疗时BCVA为(31.00±3.81)个字母数,观察终点时最佳矫正视力为(34.00±0.35)个字母数,总体差异无统计学意义(P=0.600)。患者治疗前视网膜中央厚度为(406.21±21.23)μm,随访终末时为(251.16±36.36)μm,减少值为(150.21±24.43)μm,治疗前后视网膜中央厚度比较差异有统计学意义(P=0.002)。30眼中16眼在初期治疗后视力明显提升,但随访中出现病变复发活跃后视力再次下降至基线水平;10眼在病变过程中出现不同程度黄斑下萎缩及瘢痕化改变,随访过程及随访终末视力与基线视力差异均无统计学意义(均为P>0.05);4眼由于初始CNV未累及黄斑区,在治疗随访过程中CNV稳定。结论由于病变的高复发性及强活跃性,抗VEGF药物治疗血管样条纹继发CNV远期预后并不理想,治疗仅发挥了一定维持视功能的作用。

Objective To evaluate the long-term follow-up efficacy of intravitreal injection of anti-VEGF medication for choroidal neovascularization （CNV） caused by angioid streak.Methods A retrospective observational study was conducted in 21 patients （30 eyes） diagnosed as subfoveal CNV caused by angioid streak.Demographic data,clinical course,visual acuity,and findings of fluorescein angiography and optical coherence tomography （OCT） were evaluated and observed at least 3 years after anti-VEGF treatment.Results Of all patients,the number of anti-VEGF injections was 6 to 18,with the average of 10±2.4,and the follow-up duration was 36 to 54 months,an average of （39.5±2.2）months.Moreover,the mean best corrected visual acuity （BCVA） at the baseline was （31.0±3.81） characters,and the mean BCVA was （34.0±0.35） characters at the final follow-up,and the total difference was not statistically significant （P=0.600）.The baseline central retinal thickness （CRT） was （406.21±21.23）μm and （251.16±36.36）μm at the end of the follow-up,and the difference of CRT before and after the treatment was statistically significant （P=0.002）.Visual acuity of 16 eyes in 30 eyes was significantly improved after the initial treatment,but decreased to the baseline level in the follow-up because of CNV recurrence,10 eyes occurred varying degrees of macular atrophy and scarring changes,and there was no significant difference between visual acuity of the follow-up and the baseline （all P〉0.05）,and 4 eyes had stable CNV during the follow-up because the initial CNV did not involve the macular area.Conclusion The long-term outcomes of anti-VEGF treatment for choroidal neovascularization secondary to angioid streaks is not satisfactory due to its high recurrence and activity.