雷珠单抗治疗新生血管型AMD无效病例的临床特征

Clinical analysis of invalid treatment of Ranibizumab intravitreal injection for choroidal neovascularization age-related macular degeneration

目的 研究玻璃体注射雷珠单抗（IVR）治疗新生血管型年龄相关性黄斑变性（AMD）无效病例的临床特征.方法 回顾性分析2012年3月至2014年12月在我院确诊为新生血管型AMD的106例（120只眼）病例资料.将患者分为两组,治疗有效组（A组）共79只眼;治疗无效组（B组）共41只眼.所有患者均接受前3个月每月1次IVR,后9个月按需注射治疗（PRN）.分析患者的最佳矫正视力（BCVA）,中央视网膜厚度（CRT）,是否存在视网膜层间水肿（IRF）、视网膜下积液（SRF）、视网膜色素上皮脱离（PED）,评价分析可能影响治疗效果的因素.结果 B组患者术后BCVA与术前相比差异无统计学意义（t =0.246,P＞0.05）.两组患者术后BCVA差异有统计学意义（t=0.569,P＜0.05）.B组患者的术后CRT,IRF,SRF,PED与术前相比,差异无统计学意义（t=0.937,0.736,0.672,0.639;P均＞0.05）.两组患者术后CRT,IRF,SRF,PED差异均有统计学意义（t =0.346,0.623,0.512,0.369;P均＜0.05）.BCVA与CRT,IRF,SRF,PED均呈负相关（r =-6.134,-2.458,-3.027,-4.268;P均＜0.05）.结论 IVR治疗新生血管型AMD无效的原因包括术前视力较差,发病时间较长,CNV靠近黄斑中心凹处,病灶范围较大,出现瘢痕化,CRT较厚,IRF水肿程度较重,SRF较多,并且有多处不规则PED.

Objective To evaluate the clinical features of invalid treatment of Ranibizumab intravitreal injection （IVR） for choroidal neovascularization age-related macular degeneration.Methods Retrospective analysis of 106 cases （120 eyes） of choroidal neovascularization age-related macular degeneration was made between March 2012 and December 2014.All the patients were divided into two groups,effective group （group A） included 79 eyes;invalid group （group B） included 41 eyes.All the patients were performed IVR every month for the first three months and on demand in the last 9 months.The best corrected visual acuity （BCVA）,central retinal thickness （CRT）,and whether there was inner retinal fluid （IRF）,subretinal fluid （SRF）,and retinal pigment epithelium detachment （PED） were analyzed and evaluated the influence factor of efficacy.Results The BCVA in post-operation had no significant difference compared with that in pre-operation in group B （t =0.246,P 〉0.05）.There were significant difference of BCVA between the two groups postoperatively （t =0.569,P 〈0.05）.The CRT,IRF,SRF,PED in post-operation had no significant difference compared with that in pre-operation in group B （t =0.937,0.736,0.672,0.639;all P 〉0.05）.There were significant difference of CRT,IRF,SRF,PED between the two groups postoperatively （t =0.346,0.623,0.512,0.369;all P 〈0.05）.BCVA had negative correlation with CRT,IRF,SRF,PED （r =-6.134,-2.458,-3.027,-4.268;all P 〈0.05）.Conclusions The reason of invalid treatment of IVR for neovascularization AMD include poor preoperative vision,long onset time,CNV close to fovea,large scope of lesions,scarring,thick CRT,heavy degree of IRF,much SRF,and multiple irregular PEDs.