光学相干断层扫描血管成像在康柏西普玻璃体腔内注射治疗特发性脉络膜新生血管中的应用

Application of optical coherence tomography angiography in the treatment of idiopathic choroidal neovascularization by intravitreal injection of conbercept

目的:对特发性脉络膜新生血管(ICNV)患者给予玻璃体腔内注射康柏西普治疗,并使用光学相干断层扫描血管成像(OCTA)观察其临床疗效,评估OCTA在ICNV的诊断与随访中的应用价值。方法:纳入经OCTA、光学相干断层扫描(OCT)以及荧光素眼底血管造影(FFA)确诊为ICNV患者22例(22眼),给予玻璃体腔内注射10mg/ml康柏西普0.05 ml,并连续随访6个月。每次随访均进行OCTA和OCT复查,若出现ICNV病灶扩大则及时给予再次玻璃体腔内注射康柏西普。将患者首次诊断ICNV时的FFA与OCTA检查结果进行对比,分析这两种检查的一致性。将患者治疗前与随访结束时的最佳矫正视力(BCVA)、黄斑中心厚度(CMT)以及OCTA所见的视网膜外层CNV面积和OCT所见的病灶厚度进行对比,分析治疗效果。最后,分析OCTA相对于传统检查方式的优势及其应用价值。结果:首次诊断ICNV时,OCTA检查结果中视网膜外层出现新生血管的位置和大小与FFA检查中的病灶形成对应,两者检查结果的一致性良好。患眼治疗前后的BCVA明显提升[logMAR:(0.49±0.39)vs(0.36±0.28),t=2.921,P=0.012],CMT明显降低[(285.7±50.7)μm vs(249.4±43.0)μm,t=2.608,P=0.035]。随访6个月时,OCTA的检查结果显示,17只患眼CNV面积减小,5只无明显变化。结论:OCTA可快速、清晰地显示视网膜及脉络膜各层血管,并且安全无创、结果可靠,相比传统FFA检查具有优势,对ICNV的诊断及随访观察具有重要的临床意义。

Objective To observe the clinical efficacy of intravitreous injection of conbercept in patients with idiopathic choroidal neovascularization(ICNV)using optical coherence tomography angiography(OCTA).Method Twenty-two patients(22 eyes)diagnosed with ICNV by OCTA,optical coherence tomography(OCT)and fundus fluorescene angiography(FFA)were enrolled and treated with intravitreal injection of 10 mg/ml conbercept.The injection dose was 0.05 ml.Every patient was followed up for not less than 6 months.OCTA and OCT were performed for each follow-up,and in case of ICNV lesion enlargement,another intravitreal injection of conbercept was administrated to the patient in time in order to improve the disease and save the patient's vision.The results of FFA and OCTA at the first diagnosis of ICNV were compared to analyze the consistency of the two tests.The best corrected visual acuity(BCVA),macular central thickness(CMT),the CNV area of the retinal outer layer observed by OCTA and the thickness of the lesion observed by OCT were compared before and after treatment to analyze the treatment effect.Results At the first diagnosis of ICNV,the location and size of new blood vessels in the retinal outer layer in OCTA examination corresponded to the lesion formation in FFA examination,and the results of the two examinations were in good agreement.After treatment,BCVA was significantly increased than before[logMAR:(0.49±0.39)vs(0.36±0.28),t=2.921,P=0.012],and CMT was significantly decreased[(285.7±50.7)μm vs(249.4±43.0)μm,t=2.608,P=0.035].At 6 months of follow-up,OCTA results showed a reduction in CNV area in 17 eyes and no significant change in 5 eyes.Conclusion OCTA can quickly and clearly display all layers of retinal and choroid vessels,and it is safe,non-invasive and reliable.Compared with the traditional FFA examination,OCTA has advantages in the diagnosis and follow-up observation of ICNV,and it has great clinical significance to promote the utilization of this technique in practice.