雷珠单抗和PDT治疗病理性近视合并黄斑CNV的疗效比较

Evaluation of Ranibizumab and PDT for patients with pathologic myopia and macular CNV

目的:比较抗血管内皮生长因子(VEGF)与光动力疗法(PDT)对病理性近视(PM)并发黄斑脉络膜新生血管(CNV)的治疗效果。方法:将临床上经FFA、ICGA及OCT确诊为PM合并黄斑CNV的患者43例45眼纳入观察,其中抗VEGF组20例22眼行玻璃体腔注射雷珠单抗治疗,PDT组23例23眼行PDT治疗。治疗后每月复查一次,随访12mo,根据复诊情况,按需行重复治疗。以末次随访为疗效判定时间点,记录并分析患者治疗前后ETDRS视力和视野变化。以ETDRS视力表记录最佳矫正视力(BCVA),测定中心10°视野平均缺损(MD)并比较。结果:治疗前两组基线ETDRS视力及中心视野MD比较,差异均无统计学意义(P>0.05)。治疗后12mo,抗VEGF组ETDRS视力39.23±20.06字母,较治疗前明显提高5.88±9.03字母(P<0.05);PDT组ETDRS视力37.38±16.95字母,较治疗前提高0.33±6.94字母(P>0.05)。治疗后12mo,抗VEGF组中心10°MD较治疗前明显下降(P<0.05),PDT组MD较治疗前无明显改变(P>0.05)。结论:对PM并发CNV的治疗。

AIM:To evaluate the efficacy of anti-vascular endothelial growth factor(VEGF) and photodynamic therapy(PDT) on pathological myopia(PM) combined with choroidal neovascularization(CNV).METHODS:Forty-three patients(45 eyes) diagnosed by fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA) and optical coherence tomography(OCT) with PM combined with macular CNV were recruited in this study.The patients were randomly divided into two groups for different treatments,intravitreal injection with Ranibizumab(20 patients,22 eyes) and PDT(23 patients,23 eyes).After treatment,all patients had been followed up monthly for 12 mo.The further treatments were operated according to referral situations.The best corrected visual acuity(BCVA) was recorded with the ETDRS chart and the mean defect(MD)of the center 10° visual field was measured.At the last follow-up,the therapy efficacy was determined by ETDRS numbers and MD and analyzed.RESULTS:Before treatment,there was no significant difference on the baseline in ETDRS and MD between ranibizumab group and PDT group(P>0.05).After 12 mo treatment,the ETDRS number in ranibizumab group(39.23±20.06) significantly increased(by 5.88±9.03,P<0.05),but the PDT group(37.38 ± 16.95) was not significantly improved(by 0.33±6.94,P>0.05).The MD inranibizumab group decreased significantly(P<0.05),and no significant change was found in PDT group(P>0.05). CONCLUSION:In the treatment of macular CNV complicated by the PM,ranibizumab injection can improve visual function better than PDT.