组织型纤溶酶原激活剂、雷珠单抗联合C3F8治疗息肉样脉络膜血管病变并发早期黄斑下出血的疗效观察

The efficacy of intravitreai injection of tissue plasminogen activator, ranibizumab and C3F8 in the treatment of early submacular hemorrhage induce to polypoid choroid vasculopathy

目的观察玻璃体腔注射组织型纤溶酶原激活剂（t-PA）、雷珠单抗和C3F8治疗息肉样脉络膜血管病变（PCV）并发早期黄斑下出血（SMH）的临床效果。方法临床确诊为PCV并发早期SMH的20例患者20只眼纳入研究。患眼出血持续时间7～28 d，平均出血持续时间（14.8±5.6）d。所有患眼均采用Snellen视力表测定最佳矫正视力（BCVA），并将其转换为最小分辨角对数（logMAR）视力记录；采用频域光相干断层扫描（SD-OCT）测量中央视网膜厚度（CRT）及中央视网膜色素上皮脱离（PED）厚度。患眼平均logMAR BCVA为1.73±0.91；平均CRT为（620.0±275.7）μm；平均中央PED厚度为（720.3±261.9）μm。所有患眼接受玻璃体腔注射t-PA、雷珠单抗和C3F8治疗。玻璃体腔注射雷珠单抗采用连续3个月每个月注射一次，后续按需治疗的方案。治疗后平均随访时间为（9.9±3.6）个月。将SMH清除情况分为完全清除、部分清除、无位移三种。观察治疗后6个月时患眼BCVA、CRT、中央PED厚度的变化及SMH清除情况。结果治疗后6个月，患眼平均logMAR BCVA、CRT及中央PED厚度分别为0.42±0.37、（290.2±97.4）μm、（41.6±78.1）μm。与治疗前比较，治疗后6个月患眼BCVA明显提高（F=38.14，P=0.000），CRT及中央PED厚度明显降低（F=7.48、75.94，P=0.000、0.000），差异均有统计学意义。20只眼中，SMH完全清除16只眼，占80%；部分清除4只眼，占20%。所有患者随访期间均未见SMH复发及全身、局部并发症发生。结论玻璃体腔注射t-PA、雷珠单抗、C3F8治疗PCV并发早期SMH可有效清除SMH，提高视力，降低CRT及中央PED厚度。

ObjectiveTo observe the clinical effect of intravitreal injection of tissue plasminogen activator （t-PA）, ranibizumab and C3F8 in the treatment of early submacular hemorrhage （SMH） induce to polypoid choroidal vasculopathy （PCV）.MethodsThe clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study. The duration of bleeding in the eye was 7 to 28 days, and the mean duration of bleeding was 14.8±5.6 days. All eyes are measured using the Snellen chart best corrected visual acuity （BCVA）, logarithm of the minimum angle of resolution （logMAR） was used to calculate visual acuity. Measure central retinal thickness （CRT） and central retinal pigment epithelial detachment （PED） thickness using frequency-domain optical coherence tomography. The average logMAR BCVA of eyes was 1.73±0.91; the mean CRT was 620.0±275.8 μm; the average central PED thickness was 720.3±261.9 μm. All eyes receive intravitreal injection of t-PA, ranibizumab and C3F8. The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months, followed by an on-demand treatment plan. Mean follow-up time was 9.9±3.6 months. The changes in BCVA, CRT, central PED thickness and clearance degree of SMH at 6 months after treatment were observed.ResultsOn the 6 months after treatment, the average logMAR BCVA, CRT and central PED thickness of the eyes were respectively 0.42±0.37, 290.2±97.4 μm and 41.6±78.1 μm. Compared with baseline, the after treatment BCVA was significantly increased （F=38.14, P=0.000）, but the CRT and central PED were significantly decreased （F=7.48, 75.94; P=0.000, 0.000）. Among the 20 eyes, 16 eyes of SMH was completely cleared, accounting for 80%;4 eyes was partially cleared, accounting for 20%. No recurrence and systemic or local complications occurred during follow-up of all eyes.ConclusionIntravitreal injection of t-PA, ranibizumab, and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH, improve vision, reduce CRT and central thickness of PED.