雷珠单抗加量治疗渗出型老年性黄斑变性患者的临床疗效观察

Clinical efficacy of Ranibizumab for exudative age-related macular degeneration

目的探讨伴色素上皮脱离的渗出型老年性黄斑变性患者经加量抗血管内皮生长因子药治疗后,视网膜下积液、视网膜内积液的变化和视力的改变。 方法回顾性分析伴色素上皮脱离的渗出型老年性黄斑变性老年患者31例,应用光学相干断层扫描分析治疗前和经加量雷珠单抗1mg治疗后视网膜形态变化的影像特点及治疗前后视力变化。 结果31例患者经常规剂量治疗3~17次,出现顽固的持续性和(或)复发性视网膜下液、内液伴有伴色素上皮脱离的渗出型老年性黄斑变性患者,分别接受1~3次雷珠单抗加量(1mg)治疗。患者加量治疗前中央视网膜厚度平均为(498.5±242.9)μm,加量治疗后1个月中央视网膜厚度平均为(406±201.92)μm,差异有统计学意义(t=6.025,P<0.01);85.7%(24例)的患者视网膜下积液减少、60%(9例)的患者视网膜内积液减少和67.7%(10例)的患者色素上皮脱离高度降低,19例(32.7%)患者视力提高(ETDRS提高个字母),36例(61.2%)患者视力稳定。 结论应用雷珠单抗1mg玻璃体腔内注射治疗伴有伴色素上皮脱离的渗出型老年性黄斑变性患者,可使视力提高或稳定,视网膜下积液、视网膜内积液减少和伴色素上皮脱离降低。

Objective To investigate changes in subretinal fluid(SRF), intraretinal fluid(IRF)and visual acuity after treatment with anti-vascular endothelial growth factor(VEGF)drugs in patients with wet age-related macular degeneration(WAMD)combined with disseminated epithelial detachment(PED). Methods Thirty-one WAMD patients with PED were retrospectively analyzed.Imaging characteristics of retinal morphological changes and changes in visual acuity were analyzed by optical coherence tomography(OCT)before and after treatment with Ranibizumab(1 mg). Results Thirty-one patients were treated with regular doses 3 to 17 times.WAMD patients with persistent/recurrent SRF, IRF and PED were treated with Ranibizumab(1 mg)1 to 3 times.There was a significant difference in the mean central retinal thickness(CRT)before and after 1 month of treatment(498.5±242.9 μm vs.406.0±201.9 μm, t=6.025, P<0.01).85.7% of patients(24 cases)had a decrease in SRF, 60%(9 cases)had a decrease in IRF and 67.7%(10 patients)had a decrease in PED, and 19 patients(32.7%)had increased visual acuity assessed by the Early Treatment of Diabetic Retinopathy Study(ETDRS)chart(≥ 5 letters), and 36 patients(61.2%)had stable vision. Conclusions Intravitreal injection of 1 mg Ranibizumab for the treatment of WAMD patients with PED can improve or stabilize visual acuity and reduce SRF, IRF and PED.