息肉样脉络膜血管病变患眼玻璃体腔注射雷珠单抗治疗前后眼底自身荧光影像特征观察

Changes of fundus autofluorescence in polypoidal choroidal vasculopathy before and after intravitreal ranibizumab injections

目的观察息肉样脉络膜血管病变（PCV）患眼玻璃体腔注射雷珠单抗治疗前后眼底自身荧光（FAF）图像特征。方法回顾性病例研究。临床检查确诊并有连续随访记录的PCV患者17例17只眼纳入研究。其中，男性11例11只眼，女性6例6只眼；均为单眼。所有患眼均行最佳矫正视力（BCVA）、FAF、吲哚青绿血管造影检查。采用德国海德堡公司共焦激光眼底血管造影仪HRA2行FAF检查。根据FAF强度将患眼分为弱荧光组和混合荧光组，分别为8例8只眼和9例9只眼。两组患眼BCVA分别为（58.88±11.66）、（46.56±9.15）个字母，差异无统计学意义（t=2.403，P=0.072）。所有患者均为首次治疗。患眼玻璃体腔注射10.0 mg/ml的雷珠单抗0.05 ml（含雷珠单抗0.5 mg）；治疗方案为每一个月注射1次，连续注射3个月，其后根据随访结果决定是否再次玻璃体腔注射雷珠单抗治疗。观察治疗前和治疗后3、6、12个月FAF图像特征；治疗后不同时间点BCVA变化。结果治疗前，混合荧光组患眼病灶区呈弱荧光夹杂点状、网状或片状强荧光，病灶周围强荧光；相应息肉样病灶呈融合弱荧光。弱荧光组患眼病灶区呈弱荧光，病灶周围稍强荧光；相应息肉样病灶中央无荧光，周围弱荧光围绕。两组患眼异常分支血管网（BVN）均呈颗粒状弱荧光。治疗后3个月，混合荧光组患眼息肉样病灶中央荧光增强，其周围可见强荧光环；弱荧光组患眼息肉样病灶中央呈弱荧光，其周围出现强荧光环。治疗后6、12个月，混合荧光组患眼强荧光环逐渐减弱或消失；弱荧光组患眼息肉样病灶中央荧光逐渐增强，其周围强荧光环逐渐减弱。两组患眼治疗后不同时间BVN弱荧光较治疗前无变化。与治疗前BCVA比较，两组患眼治疗后不同时间点BCVA比较，差异均无统计学意义（t=2.674、2.862、2.250，P=0.058、0.052、0.081）。末次随访时，弱荧光组、混合荧光组中视力提高的眼数分别为5、3只眼，占本组患眼的62.5%、33.3%；两组视力提高的眼数比较，差异无统计学意义（P=0.347）。结论治疗前，PCV的息肉样病灶FAF表现为中央呈无荧光区伴有周围弱荧光环，或呈融合弱荧光；治疗后息肉样病灶荧光逐渐增强，其后荧光强度趋于正常。

ObjectiveTo observe the characteristics of fundus autofluorescence （FAF） in patients with polypoidal choroidal vasculopathy （PCV） before and after intravitreal ranibizumab injections.MethodsA retrospective case series. Seventeen patients （17 eyes） including 11 males and 6 females were enrolled in this study. Best corrected visual acuity （BCVA）, FAF and indocyanine green angiography examination were performed on all eyes. The eyes were divided into hypo-autofluorescence group （8 eyes） and mixed autofluorescence group （9 eyes） according to the fluorescence degree. There was no differences of BCVA between two groups （t=2.403, P=0.072）.All eyes received monthly intravitreal ranibizumab injections for 3 months followed by an as-needed reinjection schedule. All eyes were followed up for 12 months. FAF was performed at the 3rd, 6th and 12th month after first treatment. The changes of FAF characteristics and BCVA before and after treatment were observed.ResultsBefore the treatment, the PCV lesions showed two distinct FAF patterns： the confluent hypo-autofluorescence at the polypoidal lesions and the granular hypo-autofluorescence at branching choroidal vascular networks （BVN）. During the treatment, the abnormal FAF area of the whole lesions in all eyes reduced and gradually returned to normal. At the 3rd month after treatment, the central hypo-autofluorescence of polyps was surrounded by a hyper-autofluorescence ring, and with time, the ring was weakened or eliminated. However, all the hypo-autofluorescence findings in BVN at baseline were unchanged during the follow-up period. There was no significant differences in BCVA between hypo-autofluorescence group and hyper-autofluorescence group at different follow-up times （t=2.674, 2.862, 2.250; P=0.058, 0.052, 0.081）. At final follow-up, 5 eyes （62.5%） in hypo-autofluorescence group and 3 eyes （33.3%） in hyper-autofluorescence group had increased BCVA, the different was not significant （P=0.347）.ConclusionsBefore the treatment, there were the central hypo-autofluorescence of polyps and circumferential hypo-autofluorescence ring or confluent hypo-autofluorescence. After the treatment, the autofluorescence of polyps increased and then gradually returned to normal.