摘要
目的观察光动力疗法（PDT）联合玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）治疗渗出型老年性黄斑变性（AMD）的疗效。方法临床确诊为渗出型AMD患者28例34只眼纳入研究。其中，典型性为主型脉络膜新生血管（CNV）者25只眼，轻微典型性CNV者9只眼。光相干断层扫描（OCT）检查结果显示黄斑区视网膜下液（SRF）11只眼，视网膜内液（IRF）23只眼。所有患者常规行PDT治疗后3～7d再行玻璃体腔注射bevacizumab治疗。治疗后每1个月行最佳矫正视力（BCVA）和OCT检查。OCT检查发现SRF和（或）IRF增多，或连续注射2次后，积液较上次随访无明显变化，但视力下降≥1行者行再次玻璃体腔注射治疗；若无视网膜积液者，或连续2次复查显示积液较上次随访无明显变化，且视力无下降者停止治疗。对比分析治疗前和治疗后6个月患眼的视力变化情况、视网膜厚度变化和bevacizumab注射次数。分析治疗后视力的相关影响因素，BCVA、中心视网膜厚度（CRT）与CNV类型、治疗后视网膜是否有积液之间的关系；玻璃体腔注射bevacizumab次数与CNV类型、SRF、IRF之间的关系。结果治疗后6个月，患眼平均BCVA（44．9±21．3）个字母，较治疗前提高（9．4±10．2）个字母，差异有统计学意义（t=5．438，P〈0．01）。患眼平均cRT为（177．1±95．8）μm，较治疗前下降（184．6±214．6）μm，差异有统计学意义（t=4．810，P〈0．01）。患眼玻璃体腔注射bevacizumab总次数为63次，平均注射次数为（1．9±0．9）次。治疗后6个月的视力仅与治疗前视力相关（t=0．802，P〈0．01）；与治疗前病灶大小（r=-0．183）、视网膜厚度（r=0．089）、CNV分型（r=0．053）和OCT积液分型（r=0．139）均无相关性（P〉0．05）。SRF患眼治疗后BCVA的变化多于IRF患眼，差异有统计学意义（t=-2．207，P=0．035）。CNV类型（t=-0．076）、治疗后有无积液（t—1．159）与治疗后BCVA的变化无关（P〉0．05）。治疗后CRT变化与CNV类型（t=-1．028）、OCT积液分型（t=-0．020）无关（P〉0．05）。玻璃体腔注射bevacizumab的次数与CNV类型（Z=-1．505）、（）CT积液分型（Z=-0．237）及治疗后视网膜是否有积液（Z=-1．194）均无相关性（P〉0．05）。结论PDT联合玻璃体腔注射bevacizumab治疗渗出型AMD可短期内提高患眼视力，降低患眼视网膜厚度。
Objective To investigate the effect of photodynamic therapy （PDT） combined with intravitreal bevacizumab on wet age-related macular degeneration （AMD）. Methods In this retrospective study, 34 eyes （28 cases） diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography On optical coherence tomography （OCT）, 23 eyes showed intraretinal fluid （IRF） and 11 eyes presented subretinal fluid （SRF）. After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab （1.25 rag） within succeeding 3 to 7 days. Best corrected visualacuity （BCVA） and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab （1.25 mg） was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT （＂dry macular＂）, or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness （CRT） were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension （GLD）, type of CNV, SRF or IRF and post-treatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved （9.4 ± 10.2） letters and reach 44.9±21.3 letters （t=5. 438, P〈0.01） and CRT decreased （184.6±214.6） μm （t=4. 810,P% 0.01） at 6 month visit. The average of injection number was 1.9 ± 0.9 （ inclucling initial injection of combination therapy）. With multiple lineal regression analysis, only baseline BCVA correlated to post- treatment BCVA at 6 month visit （r=0. 802, P〈0.01）. The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA （r= 0. 053, --0. 183, 0. 139 and 0. 053, respectively, P〉0.05）. BCVA of eyes with SRF （14.7 letters） increased more than eyes with IRF （6.9 letters） on OCT （t=-2.207, P=0.035）. The change of BCVAafter treatment （t=-0.076）, change of CRT （t=-1. 028） and number of injections （Z=- 1. 505） were not different between classic CNV and minimally classic CNV （P〉0.05）. The change of CRT （t= -0. 020） and number of injections （Z=- 0. 237） did not present difference between SRF and IRF （P〉0.05）. The change of BCVA （t= 1. 159） and number of injections （Z=- 1. 194） were not correlated to whether residual fluid or not at 6 month visit （P 〉0.05）. No severe complications were noticed during follow-up. Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short term.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2013年第4期356-361,共6页
Chinese Journal of Ocular Fundus Diseases
关键词
脉络膜新生血管化
药物疗法
黄斑变性
药物疗法
光化学疗法
抗体
单克隆
治疗应用
Choroidal neovascularization/drug therapy
Macular degeneration/drug therapy
Photochemotherapy
Antibodies, monoclonal/therapeutic use
