Lipofuscin-and Melanin-related Fundus Autofluorescence in Patients with Submacular Idiopathic Choroidal Neovascularization

Purpose:.To compare melanin-related near-infrared fundus autofluorescence (NIA; excitation 787 nm, emission> 800 nm) with lipofuscin-related fundus autofluorescence (FAF; excitation 488 nm, emission > 500 nm) in patients with idiopathic choroidal neovascularization (ICNV). Methods: FAF, NIA, fundus fluorescein angiography (FFA) and indocyanine green angiography.(ICGA).were obtained using a confocal scanning laser Ophthalmoscope HRA2 (Heidelberg Retina Angiograph 2).in 18 eyes of 18 patients with ICNV. Results:.Eighteen eyes had classic CNV, and autofluorescence imaging showed hypoautofluorescence at the site of CNV..A well-defined hyperautofluorescent ring was detected surrounding the CNV in all 18 eyes with NIA imaging. In our sample,.the FAF patterns around the CNV were classified as normal (n=1,.5.56%), well-defined hyperautofluorescent ring (n=7,.38.89%), or ill-defined hyperautofluorescent ring (n=10, 55.56%). Conclusion:.The patterns of FAF and NIA indicated different involvement of lipofuscin and melanin in the pathophysiological process of ICNV. Compared to FAF imaging, NIA imaging appears to be a superior noninvasive method for in vivo visualization of retinal pigment epithelium (RPE) abnormalities in ICNV patients.

Macular hole closure following anti-vascular endothelial growth factor injection in an eye with myopic choroidal neovascularization

Dear Editor,I am Cheolmin Yun,from the Department of Ophthalmology,Korea University College of Medicine.I write to present a case report of a female patient with a myopic patient suffering from atrophic choroidal neovascularization（CNV）and a full thickness macular hole（FTMH）,who was treated with an intravitreal anti-vascular endothelial growth factor （VEGF） injection without vitrectomy.

Choroidal neovascularization as the initial manifestation of multiple evanescent white dot syndrome

To report the case of a patient who presented with idiopathic choroidal neovascularization(CNV)as the first sign of multiple evanescent white dot syndrome(MEWDS).A 25-year-old woman presented with recent onset of decreased vision and metamorphopsia in the right eye.The results of fundoscopic examination,fluorescein angiography,and optical coherence tomography(OCT) were compatible with a diagnosis of idiopathic CNV,which was treated with one intravitreal injection of bevacizumab.Five years later,the patient returned complaining of photopsia and decreased vision in the same eye.The fundoscopic examination showed typical signs of MEWDS.After 3 months,recurrence of CNV was observed in the same eye.In conclusion,idiopathic CNV might be the only manifestation of a subclinical occurrence of MEWDS.In this case,it was followed by a recurrence of MEWDS and subsequent reactivation of CNV.

Anti-vascular endothelial growth factor treatment for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum： a case report and systemic review

The present study reports a case of a patient with choroidal neovascularization(CNV)associated with pseudoxanthoma elasticum(PXE).We observed the functional and anatomical improvement of the patient treated with intravitreal vascular endothelial growth factor(VEGF)inhibitor bevacizumab.The study also systematically searched the database for similar cases to provide a literature review.Data concerning the clinical features,treatment strategies and outcomes were extracted and analyzed.Retrospective interventional case report and systematic literature review.A 56-year-old healthy Chinese woman with CNV secondary to PXE was reported.Examinations included best corrected visual acuity(BCVA),biomicroscopy,optical coherence tomography(OCT),fluorescein and indocyanine green angiography and digital fundus photography.The patient managed with intravitreal anti-vascular endothelial growth factor(anti-VEGF)injections(bevacizumab 1.25 mg/0.05 m L).The Cochrane Library,Pub Med,OVID,and Up To Date databases were searched using the term pseudoxanthoma elasticum or Gr?nblad-Strandberg syndrome with the limits English.Articles that predated the databases were gathered from current references.Fundus examination revealed angioid streaks bilaterally and CNV in left eye(LE).After the patient underwent three intravitreal injections of bevacizumab,the LE showed absorption of the subretinal fluid and shrinkage of the CNV.Visual acuity(VA)was improved in her treated LE.Bevacizumab treatment was well tolerated with no adverse events reported.Approximately ten articles about 45 patients(49 eyes)describing CNV secondary to angioid streaks in PXE treated with anti-VEGF were found in the literature search.In the present case,bevacizumab of an initial three injection loading dose,achieved maintenance of visual function in the treatment of CNV associated with angioid streaks in PXE.Literature articles concluded that the intravitreal application of anti-VEGF is highly efficient for improving and stabilizing the lesion as well as the eyesight.So we believe that anti-VEGF therapy can be a great choice of treatment for CNV secondary to angioid streaks related PXE.

AB033.Implication of beta-adrenergic receptor in choroidal neovascularization

Background:We investigated the role of beta-adrenergic receptor(B-AR)on choroidal neovascularization(CNV)in an animal model of age-related macular degeneration in mice.Methods:The angiogenic effect of the B-AR was evaluated in retinal pigment epithelium(RPE)-choroid explants from C57Bl6 mice stimulated with propranolol or isoproterenol(10μM)(respectively antagonist and agonist of the B-AR)during 24 h.Conversely,a classic choroidal neovascularization(CNV)model induced by laser burn in C57Bl6 mice(8 weeks)was used to assess the anti-angiogenic effect of propranolol.In this experiment,mice were treated with intraperitoneal propranolol(6 mg/kg/d)or vehicle(saline solution)daily for 10 days,starting on day 4 after laser burn and until sacrifice(day 14).Immunostaining analysis on retinal flatmounts and cryosections were performed to determine the surface of CNV,the distribution of B-AR and the number and morphology of microglia/macrophages associated with CNV.To explore if the antiangiogenic effect of propranolol involved the modulation of the inflammatory microenvironment associated with CNV,we used RPE primary cells,J774 macrophages cell line and polarized M1 and M2 bone marrow-derived macrophage(BMDM).Choroidal explants treated with conditioned media(CM)from J774 or polarized M1/M2 BMDM pre-treated with propranolol to confirm the anti-angiogenic effect of propranolol.Expression of angiogenic factors was evaluated by RT PCR and Elisa.Results:The expression and distribution of the B-1,B-2 and B-3 adrenergic receptors were localized in the choroid and RPE cells.The stimulation of RPE-choroid explants with isoproterenol increased CNV compared to vehicle,while propranolol decreased CNV.In vivo,propranolol inhibited significantly the levels of VEGF and CNV growth in laser burn model compared to the vehicle.Additionally,the treatment with propranolol decremented the number of activated(amoeboid shape)microglia/macrophages but surprisingly,the number of non-activated microglia/macrophages around the CNV was higher than with the vehicle treatment.In vitro,propranolol modulated the angiogenic balance in macrophages promoting anti-angiogenic factors expression,especially with M2 BMDM.CM from macrophages pre-treated with propranolol reduced CNV on choroidal explants.Conclusions:These ex vivo and in vivo studies highlight the importance of B-adrenergic receptor in the CNV.Propranolol can inhibit CNV by decreasing the levels of VEGF and modulating microglia/macrophages activation.Further work will investigate the role of B-adrenergic receptor on suppression of the inflammatory environment in order to understand the link between neovascularization and inflammation in CNV during age-related macular degeneration.

Intravitreal ranibizumab therapy versus photodynamic therapy for idiopathic choroidal neovascularization： a comparative study on visual acuity, retinal and choroidal thickness

Background Photodynamic therapy （PDT） has been recommended as a main treatment for idiopathic choroidal neovascularization （I-CNV）.But the visual results of PDT were inconsistent and variable,and PDT may bring severe damage to the retinal pigment epithelium and choriocapillaries.In recent years,intravitreal ranibizumab therapy,showing favorable visual outcomes,has developed as an advanced treatment for choroidal neovascularization （CNV）.Although both methods have been reported to be effective in treating I-CNV,there is no detailed comparative report between the two methods.This study aimed to compare visual outcomes,retinal and choroidal thickness between intravitreal ranibizumab therapy and PDT in the treatment of I-CNV,and investigate the correlation of visual outcomes with retinal and choroidal thickness in each of the two groups.Methods Thirty-seven eyes of 37 patients with I-CNV were involved in this study; 19 eyes were treated with intravitreal ranibizumab therapy and 18 eyes were treated with PDT.The best corrected visual acuity （BCVA） was recorded before and at each follow-up visit after treatments （IogMAR）.Enhanced-depth imaging optical coherence tomography （EDI-OCT） was used to evaluate the retinal structural changes,and to measure central retinal thickness （CRT） and central choroidal thickness （CCT）.Results Mean BCVA was 0.64±0.27 in PDT group and 0.69±0.22 in ranibizumab group at baseline （P=0.55）.When compared with the baseline,mean BCVA in PDT group was improved significantly at 3-month after PDT （0.41±0.16,P=0.002）,then changed little （0.42±0.25 at 12-month,P=0.88）.Whereas mean BCVA in Ranibizumab group was improved significantly at each follow-up visit.It improved much more obviously in the first month and then remained stable.The mean BCVA in the ranibizumab group was significantly better at each follow-up visit than that in PDT （P ＜0.05）.When compared with the baseline,mean CRT in PDT group decreased significantly since 3-month visit,whereas mean CRT in ranibizumab group decreased significantly from 1-month visit.Mean CRT at 1-month and 3-month decreased much more in ranibizumab group than that in PDT group,almost in the same period as BCVA improving.When compared with the baseline,mean CCT did not change significantly at each follow-up visit in each group （P ＞0.05）.The CCT difference was not statistically significant between the two groups at each same time visit （P ＞0.05）.Mean BCVA was correlated with CRT,but was not correlated with CCT.Conclusions Both intravitreal ranibizumab therapy and PDT are effective for the treatment of I-CNV.It is obvious that ranibizumab therapy is significantly superior to PDT in improving BCVA and decreasing CRT.CRT decreases much more rapidly in ranibizumab group than in PDT group,simultaneously with visual improvement.CRT reduction has significant correlation with the visual outcomes in the recovery of I-CNV,whereas BCVA prognosis may have no correlation with CCT.CCT is not changed significantly after each of the treatments.Both PDT and ranibizumab therapy may have no significant effect on choroid.

Evaluation of visual functional and morphology change in young patients with idiopathic choroidal neovascularization

Background Idiopathic choroidal neovascularization （ICNV） is an uncommon disorder affecting primarily individuals younger than the age of 50 years. In CNV patients, no apparent cause can be determined. This study aimed to evaluate the functional and morphological change of the retina with ICNV in young adults. Methods In this retrospective study, 32 eyes of 32 patients with subfoveal or juxta/extra foveal ICNV had been admitted into the Shanghai First People＇s Hospital from January 2009 to July 2010. The functional changes were evaluated using the best corrected visual acuity （BCVA） and the microperimetry in the macular area.

Small laser spot versus standard laser spot photodynamic therapy for idiopathic choroidal neovascularization： a randomized controlled study

Background Idiopathic choroidal neovascularization （ICNV） affects young patients and thus may have a significant impact on vision and life quality over a patient＇s lifespan. This study was designed to compare the visual outcome and retinal pigment epithelium （RPE） damage after photodynamic therapy （PDT） with small laser spot and PDT with standard laser spot for idiopathic choroidal neovascularization （ICNV）. Methods This was a randomized controlled study. Fifty-two patients with ICNV were enrolled and randomly divided into a study group （small laser spot PDT, n=27） and a control group （standard laser spot PDT, n=25）. Best corrected visual acuity （BCVA）, optic coherence tomography （OCT） and fluorescein angiography （FA） findings were the main measurements. The patients were followed up 1 week, 1, 3, 6, 9 months and 1 year after PDT. Results BCVA improvement was statistically significantly higher in the study group than the control group at 6-month （（25.53±15.01） letters vs. （14.71±11.66） letters, P=-0.025） and 9-month follow-ups （（27.53±17.78） letters vs. （15.59±12.21） letters, P=0.039）. At 3- and 6-month follow-ups, the quadrants of RPE damage between the two groups varied significantly （P 〈0.001 and P=0.023, respectively）. In each follow-up, the number of cases with decreased or unchanged leakage of choroidal neovascularization by FA and reduced subretinal fluid by OCT did not vary significantly between the two groups. Ten cases （37.0%） in the study group and eight cases （32.0%） in the control group suffered from recurrent CNV （P=-0.703）. Conclusions Better visual improvements, less RPE damage, a similar recurrent rate of CNV and change of subretinal fluid were observed in the small laser spot PDT group than in the standard laser spot PDT group for ICNV.

PDT治疗病理性近视黄斑部CNV的多焦视网膜电图变化观察

目的:应用多焦视网膜电图(multifocal electroretinogram,mfERG)评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视(pathological myopia,PM)合并黄斑下脉络膜新生血管(choroidal neovascularisation,CNV)早期视网膜功能的改变。方法:经临床确诊的继发于PM的CNV患者30例(30眼),根据CNV的位置将患眼分为中心凹下CNV组(19例19眼)和旁中心凹CNV组(11例11眼),在治疗前及治疗后1wk;1和3mo对各患眼6个环状视网膜区域的N1,P1波潜伏期和平均反应密度进行检测。结果:中心凹下CNV组治疗后1和3mo时mfERG3～5环N1、P1波振幅密度值与治疗前均显著提高(P<0.05)。旁中心凹CNV组治疗后1wk和1mo3～5环N1波振幅密度值与治疗前对比均有明显提高(P<0.05),3mo3～4环N1波振幅密度值显著提高(P<0.05),治疗后1wk;1和3mo3～4环P1波振幅密度值与治疗前比均有明显提高(P<0.05)。结论:mfERG显示PDT治疗能有效改善继发于PM的CNV患眼黄斑中心凹外的视功能。

抗VEGF药物治疗特发性脉络膜新生血管预后影响因素及预测模型构建

目的:探讨抗血管内皮生长因子(VEGF)药物治疗特发性脉络膜新生血管预后影响因素并构建相关预测模型。方法:回顾性纳入2020-01/2023-06于我院接受抗VEGF药物治疗特发性脉络膜新生血管患者57例57眼,根据治疗后病灶消退及复发情况分组;对抗VEGF药物治疗特发性脉络膜新生血管病灶消退及新生血管复发的影响因素进行单因素分析。对抗VEGF药物治疗特发性脉络膜新生血管病灶消退及新生血管复发的影响因素进行多因素分析。构建抗VEGF药物治疗特发性脉络膜新生血管病灶消退的临床预测模型。结果:患者抗VEGF药物治疗后病灶消退17眼(30%),复发13眼(23%)。单因素分析结果显示,病程、基线最佳矫正视力水平及基线黄斑中心凹视网膜厚度均可能与抗VEGF药物治疗特发性脉络膜新生血管病灶消退及新生血管复发有关(均P<0.05)。Logistic多因素分析结果证实,病程、基线最佳矫正视力水平及基线黄斑中心凹视网膜厚度是抗VEGF药物治疗特发性脉络膜新生血管病灶消退的影响因素(均P<0.05),而与抗VEGF药物治疗特发性脉络膜新生血管复发无关(均P>0.05)。利用回归模型的影响因素以及P值预测概率对抗VEGF药物治疗特发性脉络膜新生血管病灶消退进行预测,约登指数分别为83.00%、75.74%、45.47%、85.00%。结论:抗VEGF药物治疗特发性脉络膜新生血管病灶消退与病程、基线最佳矫正视力水平及基线黄斑中心凹视网膜厚度密切相关,而复发风险尚未得到相应的影响因素;利用以上3个因素构建的数据模型对于患者的抗VEGF药物治疗特发性脉络膜新生血管病灶消退预测显示出良好的效能。

AMD并发CNV的影像学研究及相关因素分析

目的：研究FFA和OCT对AMD并发CNV观察的相关性,及AMD并发CNV的相关危险因素分析。方法：回顾性分析自2006年5月~2008年3月期间在我院就诊的81例（127眼）的AMD患者均经裂隙灯、显微立体检眼镜、FFA、眼底照相及OCT检查。根据FFA及OCT各自检查出CNV的病例数,将结果用卡方检验进行统计学分析;根据这组已确诊为AMD并发CNV患者的年龄、性别、教育程度、高血压、远视及吸烟史进行统计,并运用多因素Logistic回归分析法进行统计学分析。结果：以OCT为依据诊断出AMD并发CNV的患者55例（87眼）,以FFA为依据诊断出AMD并发CNV的患者26例（32眼）,2者对CNV的检出率有显著的统计学意义（χ2=41.95,p〈0.01）。年龄、教育程度、高血压及吸烟史与AMD并发CNV的发生有显著的统计学意（p〈0.05）;性别、远视与AMD并发CNV的发生无显著的统计学意义（p〉0.05）。结论：在AMD并发CNV的诊断中OCT与FFA相比具有优异的敏感性和准确率,是AMD并发CNV诊断的首选检测方法。高龄、低学历、高血压、吸烟是发生AMD并发CNV的危险因素。

OCTA与ICGA检查在CNV和PCV中的影像对比分析

目的:对比观察脉络膜新生血管(CNV)与息肉状脉络膜血管病变(PCV)在吲哚菁绿血管造影(ICGA)与光学相干断层扫描血管成像(OCTA)中的特征性表现,探讨二者的区别和优缺点。方法:回顾分析2018-09/2020-04在河北省眼科医院确诊的CNV患者26例34眼和PCV患者19例19眼的影像学资料,CNV患者中湿性年龄相关性黄斑变性(w-ARMD)20例28眼,慢性中心性浆液性脉络膜视网膜病变(CCSC)继发CNV 6例6眼。所有患者均行OCTA、荧光素眼底血管造影(FFA)+ICGA检查,分析其特征性改变。结果:w-ARMD患者28眼OCTA检查示,除2眼因出血较多未见明显异常外,余26眼均可显示CNV形态,呈现效果形态更加锐利、立体,且能够分辨出CNV所在的解剖层面,其中11眼OCTA检查不仅能够很好地显示出CNV的形态、大小、范围,而且对于CNV中的滋养血管、新生血管及吻合支也都能较好地分辨。CCSC继发CNV患者6眼OCTA发现了FFA+ICGA未发现的CNV形态。PCV患者19眼OCTA检查异常脉络膜分支血管网(BVN)显示优于ICGA,但OCTA图像上末端囊袋样扩张(polyps)的显示及数量不如ICGA明显,部分不能显示。结论:OCTA检测CNV阳性率较ICGA高,检测CNV和PCV病变范围较ICGA更清晰、立体,但在PCV中不能全部显示末端囊袋样扩张,且不能观察CNV或PCV渗漏情况及病变动态发展过程,较FFA+ICGA尤为不足。OCTA作为无创检查可以随访观察CNV或PCV治疗前后病变发展情况。

维替泊芬的药理和临床应用

通过文献检索综述了维替泊芬的药理作用、药动学及临床评价。维替泊芬是一种新型光敏剂,临床上用于治疗老年性黄斑(ARMD)等疾病,不良反应主要为头痛、注射部位反应、视觉障碍等。

经瞳温热疗法治疗湿性年龄相关黄斑变性的疗效观察

目的:探讨经瞳温热疗法(tran spupillarty thermother-apy,TTT)治疗湿性年龄相关黄斑变性(age-related macular degeneratio,nARMD)的初步疗效。方法:对9例14眼经眼底检查、荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚菁绿眼底血管造影(indocyanine greenangiography,ICGA)确诊为湿性ARMD(12眼为隐匿型、2眼为经典型)的患眼行TTT治疗。根据脉络膜新生血管膜(choroidal neovascular membrane,CNV)的范围选择不同的光斑大小和能量,术后对眼底改变、视力、眼底血管造影复查,随访1～22(平均11.67)mo,以观察疗效。结果:经TTT治疗后,至末次复查时11眼(79%)出血、水肿、渗出消失、病灶斑痕化,3眼(21%)的出血、水肿、渗出明显减轻。5位患者的8眼患眼有TTT后的FFA及ICGA复查,显示其中6眼的原病灶渗漏消失、CNV消退,2眼的渗漏明显减轻。治疗后视力提高的有4眼(29%),稳定的有7眼(50%),下降的有3眼(21%)。除2位患者的2只患眼(14%)分别在第一次治疗后的第4和第5mo经造影复查后,接受了原病灶的再次TTT外,其余患眼(86%)均只进行了一次TTT。结论:TTT对湿性ARMD有较明确的疗效,经济安全,其远期疗效需更多病例观察。

玻璃体腔注射bevacizumab治疗特发性脉络膜新生血管膜的临床观察

目的观察玻璃体腔注射bevacizumab治疗特发性脉络膜新生血管(CNV)的临床效果。方法采用单中心非随机对照临床回顾性研究,对经间接检眼镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊的特发性CNV患者共43例(45眼),病程5d～3年,均为中心凹下CNV和旁中心凹下CNV。行bevacizumab玻璃体腔注射1.25mg(0.05mL),注射次数为1～5次,间隔6周,治疗后随访3～12个月,对比分析术前术后的视力、眼底、FFA及OCT表现。结果平均logMAR视力,术前为0.66±0.35,术后为0.29±0.27,术前术后比较差异有统计学意义(P<0.01)。视力平均提高(3.5±2.4)行。OCT显示平均中央视网膜厚度(CFT),术前为(358±103)μm,术后为(229±114)μm,术前术后比较差异有统计学意义(P<0.01)。CFT平均下降(129±116)μm。FFA显示渗漏消失者24眼,减少者17眼,渗漏持续者4眼。眼局部除3例有小片结膜下出血外,未出现其他并发症。结论玻璃体腔注射bevacizumab治疗特发性CNV安全有效,但其长期的疗效和安全性评价尚需进行多中心、大样本的临床随机对照研究。

玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管

目的评价玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管的疗效。方法对经间接检眼镜、FFA及OCT检查确诊的特发性脉络膜新生血管患者31例(32眼)行玻璃体腔注射雷珠单抗治疗,注射策略为1+PRN,治疗后1 d,2周,1、3个月复查,比较注射前后BCVA(Log MAR视力)、OCT及FFA变化。结果术后1个月BCVA及中心凹视网膜厚度均较注射前有明显改善。FFA检查脉络膜新生血管渗漏明显改善。注射后2例一过性眼压轻度升高以及部分病人有小片结膜下出血,无其他严重并发症。结论玻璃体腔注射雷珠单抗是治疗特发性脉络膜安全、有效的方法。

玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管的长期疗效

目的观察玻璃体腔注射雷珠单抗(IVR)治疗特发性脉络膜新生血管(ICNV)的长期疗效,探索影响疗效的指标。方法采用回顾性自身对照研究,收集经IVR治疗的确诊为ICNV的61例61眼患者数据资料,对比IVR治疗前后其最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CRT)、视网膜色素上皮层脱离(PED)高度以及椭圆体带(EZ)缺失长度的变化,分析不同IVR治疗次数以及不同ICNV分型初诊时各项临床指标的情况。结果患者随访时间平均为(41.5±4.6)个月。治疗前和末次随访时患者BCVA(LogMAR)分别为0.59±0.32和0.17±0.12,CRT分别为(331.18±80.42)μm和(245.07±44.67)μm,PED高度分别为(246.73±104.75)μm和(205.78±117.01)μm,EZ缺失长度分别为(2 315.10±1 233.77)μm和(1 325.98±1 157.30)μm,治疗前后对比,差异均有统计学意义(均P<0.05);第1年内结束治疗例数为53例,3次注药内完成治疗例数为53例,均占总例数的86.89%;IVR治疗≥3次组CRT显著高于IVR治疗2次组和IVR治疗1次组,IVR治疗≥3次组PED高度显著高于IVR治疗1次组,差异均有统计学意义(均P<0.05)。黄斑中心凹下型、黄斑中心凹旁型和黄斑中心凹外型患者平均注药次数总体比较,差异无统计学意义(F=1.982,P>0.05)。结论IVR治疗ICNV后患者BCVA、CRT、PED高度及EZ缺失长度均有明显改善,绝大多数患者疗程为1年以内,治疗次数≤3次,患者初诊时的CRT及PED高度值可能是影响其最终行IVR治疗次数的因素。

光动力疗法联合玻璃体内注射Bevacizumab治疗病理性近视合并脉络膜新生血管

目的观察光动力疗法(photodynamic therapy,PDT)联合玻璃体内注射Bevacizumab治疗病理性近视(pathologicalmyopia,PM)合并脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效和安全性。方法回顾性分析68例(68眼)PM患者的临床资料。先行PDT治疗后1周内,行玻璃体内注射Bevacizumab1.5mg(0.06mL)。术后1个月、3个月、末次随访时,复查最佳矫正视力、眼底彩照、FFA、ICGA、OCT。随访时,发现CNV部分闭合或仍有渗漏者给予再次玻璃体内注射Bevacizumab。比较联合治疗前后最佳矫正视力、眼底彩照、FFA、ICGA、OCT检查结果,观察其疗效及安全性。结果术后1个月、3个月和末次随访时最佳矫正视力均较治疗前明显提高(F=33.149,P=0.000)。治疗后末次随访时,视力提高2行以上43眼(63·24%),视力稳定22眼(32.35%),视力下降2行以上3眼(4.41%)。眼底检查及眼底照相显示病灶缩小,出血及神经上皮水肿完全吸收或消失。54眼(79.41%)CNV完全闭合,无荧光素渗漏;14眼(20.59%)CNV大部分闭合,轻微荧光素渗漏。所有治疗眼OCT显示神经上皮水肿消失,CNV强反射区域明显缩小。所有治疗眼均接受1次PDT治疗,36眼行1次玻璃体内注射Bevacizumab,20眼行2次,12眼行3次,Bevacizum ab玻璃体内注射平均次数1.65次。结论 PDT联合玻璃体内注射Bevacizum ab治疗PM合并CNV是安全有效的,可有效封闭CNV,提高视力。

玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管的临床观察

目的观察玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管的临床效果。方法采用非随机对照临床回顾性研究,对经直接或间接检眼镜、荧光素眼底血管造影和吲哚青绿脉络膜血管造影以及光学相干断层扫描检查确诊的特发性脉络膜新生血管患者共32例(32眼),病程10d～1a,行玻璃体腔注射25g.L-1Bevacizumab治疗,注射次数为1～3次,间隔4周,治疗后随访4～18个月,对比分析术前与末次随访的视力、眼底、荧光素眼底血管造影和吲哚青绿脉络膜造影检查显示的渗漏以及光学相干断层扫描检查显示的平均中央视网膜厚度的变化。结果术前和末次随访时平均logMAR视力分别为0.23590±0.19751和0.39750±0.27287,治疗前后比较差异有显著统计学意义(t=-5.530,P<0.001)。OCT显示术前平均中央视网膜厚度为(317.72±75.01)μm,末次随访为(206.28±31.56)μm,治疗前后比较差异有显著统计学意义(t=8.857,P<0.001)。造影显示渗漏消失者18眼,减少者12眼,渗漏持续者2眼。随访期间有5眼出现小片结膜下出血,1眼出现少量玻璃体腔出血,注射后第2天3眼眼压有明显下降,未见其他并发症。2例病情复发,复发率为6.25%,复发病例进行再次注射治疗仍有疗效。结论玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管安全有效,但其长期的疗效和安全性评价尚需进行多中心、大样本的临床随机对照研究。

高度近视黄斑区脉络膜新生血管光学相干断层扫描分析

目的探讨高度近视黄斑部视网膜下脉络膜新生血管(CNV)患者的光学相干断层扫描(OCT)图像特征。方法对16例(17眼)病理性高度近视连续治疗患者进行OCT检查,并与荧光素眼底血管造影(FFA)和吲哚青绿眼底血管造影(ICGA)结果进行对比;同时对光动力治疗后患者的OCT图像形态变化进行分析。结果17眼中有12眼CNV呈类圆形团块状,自视网膜色素上皮层向上突出,位于视网膜神经上皮下间隙,呈强或中等强度反射;5眼的CNV呈纺锤形或不规则形,亦呈强或中等强度反射,位于色素上皮层平面。17眼中9眼伴浆液性神经上皮脱离,11眼伴出血性色素上皮脱离,14眼伴不同程度视网膜水肿和增厚。12眼经光动力治疗(PDT)后,FFA检查显示荧光素渗透消退或减弱,OCT检查显示CNV团块不同程度退缩,形态亦发生变化。结论OCT检查可确定高度近视黄斑病变中CNV团块的形态、大小及位置。高度近视黄斑病变中CNV的OCT图像以突出于色素上皮层的类圆形团块为特征,形态和大小可因治疗和观察时间而变化。