雷珠单抗联合光动力疗法治疗湿性年龄相关性黄斑变性患者眼压和视力效果及对血清VEGF、TGF-β1的影响

Effectiveness and Effects of Ranibizumab Combined with Photodynamic Therapy on Intraocular Pressure,Visual Acuity and Serum VEGF and TGF-β1 of Patients with Wet-type Age-related Macular Degeneration

目的研究雷珠单抗(IVR)联合光动力疗法(PDT)对湿性年龄相关性黄斑变性(w AMD)患者眼压、视力的疗效和对血清血管内皮生长因子(VEGF)、转换生长因子-β1(TGF-β1)的影响。方法选取2015年3月—2017年3月我院眼科收治的w AMD患者60例,共71只患眼,治疗方法分为观察组30例(36只),对照组30例(35只)患眼。对照组给予玻璃体内注射雷珠单抗,观察组在对照组基础上给予PDT。随访6个月,比较2组重复治疗次数、不良反应和并发症发生率;观察并记录2组眼压、视力、中心凹视网膜厚度(CRT)和脉络膜新生血管(CNV)渗漏情况;检测并比较2组VEGF与TGF-β1浓度。结果治疗后6个月,观察组IVR重复治疗次数低于对照组(P <0. 05); 2组并发症、不良反应发生率和眼压比较无统计学意义(P> 0. 05)。治疗后1、3、6个月,2组最佳矫正视力均呈上升趋势,且观察组高于对照组(P <0. 05),CRT均呈降低趋势,且观察组低于对照组(P <0. 05)。治疗后3个月,2组CNV比较差异无统计学意义(P> 0. 05);治疗后6个月,观察组CNV闭合率高于对照组,复发率低于对照组(P <0. 05)。治疗3个月后,2组VEGF及TGF-β1浓度均低于治疗前,且观察低于对照组(P <0. 05)。结论雷珠单抗联合PDT治疗可有效提高w AMD患者视力,降低CNV复发率,治疗效果良好且安全性高。

Objective To explore Effectiveness and effects of intravitreal injection of Ranibizumab(IVR)combined with photodynamic therapy(PDT)on intraocular pressure,visual acuity,serum vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGF-β1)in treatment of patients with wet-type age-related macular degeneration(wAMD).Methods A total of 60 wAMD patients(71 affected eyes)admitted during March 2015 and March 2017 were divided into observation groups(n=30,36 affected eyes)and control group(n=30,35 affected eyes)according to therapeutic methods.Control group was treated with IVR,while observation group was added with PDT on the basis of treatment for control group.During 6 months of follow-up in two groups,repeated treatment frequency and incidence rates of adverse reaction and complications were compared;conditions of intraocular pressure,visual acuity,central retinal thickness(CRT)and the leakage of choroidal neovascularization(CNV)were observed and compared;concentrations of vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGF-β1)were detected and compared.Results After 6 months of treatment,frequency of repeated IVR treatment in observation group was significantly lower than that in control group(P<0.05),and there were no significant differences in incidence rates of complications and adverse reaction and intraocular pressure between the groups(P >0.05).After 1 month,3 months and 6 months of treatment,the best corrected visual acuity showed ascending trend in two groups,and the values in observation group were significantly higher than those in control group(P<0.05);CRT values showed a decreasing trend in two groups,and the values in observation group were significantly lower than those in control group(P<0.05).After 3 months of treatment,there was no significant difference in CNV leakage between two groups(P >0.05).After 6 months of treatment,in observation group,CNV closure rate was significantly higher,while recurrence rate was significantly lower than those in control group(P<0.05).After 3 months of treatment,concentrations of VEGF and TGF-β1 were significantly decreased compared with those before treatment in two groups,and the concentrations in observation group were significantly lower than those in control group(P<0.05).Conclusion Ranibizumab combined with PDT in treatment of patients with wet-type age-related macular degeneration may effectively improve visual acuity and reduce recurrence rate of CNV with good effectiveness and safety.