玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉状脉络膜血管病变的临床观察

Clinical observation on the treatment of polypoidal choroidal vasculopathy with intravitreal ranibizumab injection and photodynamic therapy

目的观察玻璃体腔注射雷珠单抗联合光动力疗法(PDT)治疗息肉状脉络膜血管病变(PCV)的临床疗效。方法回顾性分析在我院确诊为PCV的患者15例(16只眼),所有患者均行最佳矫正视力、前置镜下眼底检查、相干光断层扫描(OCT)、吲哚氰绿脉络膜血管造影(ICGA)、荧光素眼底血管造影(FFA)、眼底彩色照相检查。所有患者按照常规内眼手术操作要求给予玻璃体腔内注射雷珠单抗0.5 mg/0.05 ml,注射后3 d联合PDT治疗,随访6个月。分析比较患者治疗前后的黄斑中心凹视网膜厚度(CRT)和视力变化,以及黄斑区出血渗出吸收和息肉样病灶消退情况。结果 15例患者16只眼在治疗前的平均视力为(0.92±0.62)logMAR,经治疗6个月后的平均视力为(0.53±0.27)logMAR,较治疗前显著提高了(0.39±0.32)logMAR,差异具有统计学意义(t=2.416,P<0.05)。治疗前患者的平均CRT厚度为(358.17±141.29)μm,治疗6个月后的平均CRT厚度为(218.29±50.23)μm,较治疗前显著降低(138.29±129.33)μm,两组数据比较差异具有统计学意义(t=4.492,P<0.05)。经FFA及ICGA检查结果显示,有3只眼(18.8%)息肉样病灶表现为减少,有13只眼(81.2%)息肉样病灶表现为完全消退。结论玻璃体腔注射雷珠单抗联合PDT治疗PCV是安全有效的,有利于提高患者的视力,减轻视网膜水肿,降低CRT,减少病灶渗漏。

Objective To investigate the clinical efficacy of combined intravitreal ranibizumab injection and photodynamic therapy（ PDT） in the treatment of polypoid choroidal vasculopathy（ PCV）. Methods Clinical data of 15 patients（16 eyes） diagnosed with PCV were retrospectively studied. All patients were examined with optical coherence tomography（ OCT）,indocyanine green angiography（ ICGA） and fundus fluorescein angiography（ FFA）,fundus color photography and visual inspection. They were injected with ranibizumab（0. 5 mg/0. 05 ml） before PDT therapy and were followed up for 6 months. Central retina thickness（ CRT）,vision changes,macular hemorrhage absorption and polypoidal lesions were analyzed. Results Average visual acuity before treatment was 0. 92 ± 0. 62 logMAR and significantly improved to 0. 53 ± 0. 27 logMAR after treatment（ t = 2. 416,P〈 0. 05）. Average CRT was 358. 17 ± 141. 29 μm before treatment and decreased to 218. 29 ± 50. 23 μm at 6 months after treatment（ t = 4. 492,P〈 0. 05）. FFA and ICGA showed that in 3 eyes（18. 8%） there was a decrease in polypoidal lesions,and there were 13 eyes（81. 2%） showed complete regression of the polypoidal lesions. Conclusions Intravitreal injection of ranibizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy has good clinical results and significantly improves visual acuity and retinal edema. It is worthy of promotion in clinical use.