高度近视圆顶状黄斑合并脉络膜新生血管的临床特点及玻璃体腔注射抗血管内皮生长因子药物治疗的疗效分析

Clinical characteristics and curative effect of high myopia dome-shaped macula complicated with choroidal neovascularization

目的观察高度近视圆顶状黄斑(DSM)合并脉络膜新生血管(CNV)的临床特征及玻璃体腔注射抗血管内皮生长因子(VEGF)药物的疗效。方法回顾性临床研究。2019年1月至2023年12月于佛山市第二人民医院眼科检查确诊的高度近视DSM合并CNV患者23例23只眼纳入研究。患眼均行最佳矫正视力(BCVA)、眼压、光相干断层扫描(OCT)检查。BCVA检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪测量DSM高度以及黄斑中心凹厚度(CMT)、脉络膜厚度(ChT)。根据OCT图像特征将DSM分为水平、垂直方向椭圆形凸起和圆形凸起。参照文献标准将CNV分为中心凹下CNV和中心凹旁CNV。患眼均给予玻璃体腔注射雷珠单抗或康柏西普(IVR或IVC)0.05 ml治疗。治疗方案为1+按需治疗。首次行IVR、IVC治疗分别为17、6只眼,并据此再分为IVR组、IVC组。治疗后随访时间≥1个月。观察患者的临床特点及治疗后BCVA、眼压、CMT、ChT的变化。组间比较采用独立样本t检验。结果23例23只眼中,男性7例7只眼,女性16例16只眼;右眼、左眼分别为11、12只眼;年龄(49±16)岁;logMAR BCVA 0.94±0.39。DSM形态呈水平、垂直方向椭圆形凸起和圆形凸起分别为13(56.52%,13/23)、6(26.09%、6/23)、4(17.39%,4/23)只眼。圆顶高度为(97.83±46.14)μm。CMT、ChT分别为(276.39±98.35)、(49.48±31.66)μm。IVR组17例17只眼中,男性4例,女性13例。IVC组6例6只眼中,男性3例、女性3例。末次随访时,患眼logMAR BCVA、CMT分别为0.60±0.39、(209.96±71.38)μm;与治疗前比较,BCVA显著提高,CMT显著降低,差异均有统计学意义(t=2.98、2.62,P=0.005、0.010)。治疗后1个月、末次随访时,IVR组、IVC组患眼BCVA提高程度(t=1.47、1.35)、眼压变化(t=−0.20、−0.56)、ChT降低厚度(t=0.80、−0.62)比较,差异均无统计学意义(P>0.05)。治疗后1个月及末次随访时,IVR组、IVC组患眼CMT分别较治疗前降低(57.94±67.61)、(83.17±78.37)μm和(13.33±9.73)、(18.17±17.88)μm,差异均有统计学意义(t=2.64、3.21,P<0.05)。结论玻璃体腔注射雷珠单抗或康柏西普治疗高度近视DSM合并CNV,均能有效提高患眼BCVA;雷珠单抗降低CMT的程度优于康柏西普。

Objective To observe the clinical features of high myopia domed-shaped macula(DSM)complicated with choroidal neovascularization(CNV)and the efficacy of intravitreal injection of anti-vascular endothelial growth factor(VEGF).Methods A retrospective clinical study.A total of 23 eyes of 23 patients with high myopia DSM combined with CNV diagnosed by ophthalmology examination in Department of Ophthalmology of The Second People's Hospital of Foshan from January 2019 to December 2023 were included in the study.Best corrected visual acuity(BCVA),intraocular pressure,optical coherence tomography(OCT)were performed in all eyes.BCVA tests are performed using the international standard visual acuity chart,which was statistically converted to logarithm of the minimum angle of resolution(logMAR)visual acuity.DSM height,central macular thickness(CMT)and choroidal thickness(ChT)were measured by OCT.According to OCT image features,DSM was divided into horizontal and vertical elliptic bulges and circular bulges.According to the literature standard,CNV was divided into subfoveal CNV and parafoveal CNV.All patients were treated with 0.05 ml intravitreal injection of ranibizumab or conbercept(IVR or IVC).The treatment regimen was 1+on-demand treatment.The first IVR and IVC treatment were performed on 17 eyes and 6 eyes,respectively,and were divided into IVR group and IVC group.Follow-up time≥1 month after treatment.The clinical features of the patients and the changes of BCVA,intraocular pressure,CMT and ChT after treatment were observed.Independent sample t test was used for comparison between groups.Results There were 23 eyes in 23 cases,7 males had 7 eyes and 16 females had 16 eyes.There were 11 and 12 eyes in the right and left eyes respectively.Age were(49±16)years old;logMAR BCVA was 0.94±0.39.Shapes of DSM were in 13(56.52%,13/23),6(26.09%,6/23),and 4(17.39%,4/23)eyes,respectively.The dome height was(97.83±46.14)μm.CMT and ChT were(276.39±98.35)and(49.48±31.66)μm,respectively.There were 17 eyes in the IVR group,including 4 males and 13 females.There were 6 cases in the IVC group,3 cases were male and 3 cases were female.At the last follow-up,logMAR BCVA and CMT were 0.60±0.39 and(209.96±71.38)μm,respectively.BCVA was significantly increased and CMT was significantly decreased compared with before treatment,with statistical significance(t=2.98,2.62;P=0.005,0.010).One month after treatment and at the last follow-up,there were no significant differences in the degree of BCVA improvement(t=1.47,1.35),intraocular pressure change(t=−0.20,−0.56)and ChT reduction thickness(t=0.80,−0.62)between IVR group and IVC group(P>0.05).At 1 month after treatment and last follow-up,the CMT of patients in IVR group and IVC group was decreased by(57.94±67.61),(83.17±78.37)μm and(13.33±9.73),(18.17±17.88)μm compared with that before treatment,respectively,and the differences were statistically significant(t=2.64,3.21;P<0.05).Conclusions IVR or IVC in the treatment of high myopia DSM combined with CNV can effectively improve BCVA.The reduction of CMT with ranibizumab is better than conbercept.