摘要
目的:研究真实世界下玻璃体腔内注射抗VEGF药物治疗眼底疾病的疗效。方法:选择2012-09/2015-08在我科应用抗VEGF药物的临床病例,回顾性调查抗VEGF药物应用的病种、频次、用法、疗效、不良反应,以及其对视力、眼底情况及黄斑中心凹厚度等指标的影响。结果:选取接受抗VEGF药物玻璃体腔内注射治疗的患者305例340眼,其中53例60眼(17.6%)为湿性年龄相关性黄斑变性(AMD)、16例18眼(5.3%)息肉样脉络膜血管病变(PCV)、120例134眼(39.4%)为糖尿病性黄斑水肿(DME)、61例68眼(20.0%)为视网膜分支静脉阻塞(BRVO)合并黄斑水肿、29例32眼(9.4%)为视网膜中央静脉阻塞(CRVO)合并黄斑水肿、16例18眼(5.3%)特发性脉络膜新生血管、4例4眼(1.2%)高度近视伴发脉络膜新生血管、4例4眼(1.2%)新生血管性青光眼、1例1眼(0.2%)视网膜血管瘤样增生(RAP)和视乳头新生血管1例1眼(0.2%)。年龄为16~90岁。247例275眼(80.9%)使用雷珠单抗注射液,58例65眼(19.1%)使用康柏西普注射液。所有患者共计接受抗VEGF药物治疗次数为565次,平均为1.7次/眼。其中,采用"3+按需治疗(PRN)"治疗方法的有98例109眼(32.1%),"1+PRN"治疗方法的有207例231眼(67.9%)。单独使用抗VEGF药物69例77眼(22.6%),联合曲安奈德玻璃体腔注射10例11眼(3.2%),联合玻璃体切割手术35例39眼(11.5%),联合PDT治疗26例29眼(8.5%),联合单纯眼底激光治疗例165例184眼(54.1%)。经抗VEGF药物治疗后,绝大多数的最矫正视力(BCVA)、眼底情况和黄斑中心凹厚度(CMT)均有明显改善,与术前相比较,差异有统计学意义(P<0.05)。表明抗VEGF药物可以有效地改善眼底疾病的视功能和眼底情况。本组病例在应用抗VEGF药物治疗期间,除有3例出现皮肤发红、瘙痒、皮疹,1例出现低热和1例出急性脑梗塞等不良事件外,其余均未发生其他严重不良反应。结论:玻璃体腔内注射抗VEGF药物能明显改善眼底疾病的视功能和眼底情况,但临床尚存在一些不良事件的发生。
AIM：To understand the clinic effect of intravitreal anti- vascular endothelial growth factor（VEGF） drugs injection in the treatment of fundus disease in the real-world study （RWS）. METHODS： The clinical cases treated with anti-VEGF drugs in our department from September 2012 to June 2015 were enrolled in this study. Retrospective investigation was reviewed to the kinds of diseases, frequency, usage, efficacy, adverse reaction, and the effects on visual acuity, fundus and macular thickness which were treated with intravitreal anti- VEGF drugs injection. RESULTS： In 305 patients （340 eyes） treated with anti- VEGF drugs, 53 patients （60 eyes, 17.6%） were wet age- related macular degeneration （ AMD ）, polypoidal choroidal vasculopathy （PCV） 16 cases （18 eyes, 5.3% ）, diabetic macular edema （DME） 120 cases （134 eyes, 39.4%）, branch retinal vein occlusion （BRVO） secondarymacular edema 61 cases （68 eyes, 20.0% ）, central retinal vein occlusion （CRVO） secondary macular edema 29 cases （ 32 eyes, 9. 4%）, idiopathic choroidal neovascularization （ICNV） 16 cases （18 eyes, 5. 3%）, high myopia with choroid neovascularization 4 cases （4 eyes, 1. 2%）, neovascular glaucoma 4 cases （4 eyes, 1.2%）, retinal angiomatous proliferation （RAP） 1 cases （1 eyes, 0.2%） and optic papillary neovascularization 1 cases （1 eyes, 0.2%）. The minimum age was 16 years old, and the maximum age 90 years old. There were 247 cases （275 eyes, 80. 9%） were treated with intravitreal ranibizumab injection, 58 cases （65 eyes, 19. 1%） intravitreal conbercept injection. The time number of all patients accepted anti-VEGF drugs treatment was 465, with an average of 1.7 times per eye. Which, the ＂ 3 ＋ PRN＂ treatment method in 98 patients （109 eyes, 32.1% ）, ＂1 ＋ PRN＂ treatment in 207 patients （231 eyes, 67.9%）. 69 cases （77 eyes, 22.6% were used alone to receive anti- VEGF drugs therapy, 10 cases （11 eyes, 3.2%） combined with intravitreal triamcinolone injection（iTA）, 35 cases （39 eyes, 11.5%） combined with vitrectomy, 26 cases （29 eyes, 8. 5%） combined with photodynamic treatment （PDT）, 165 cases （184 eyes, 54. 1%） combined with simple laser treatment. After anti-VEGF drug treatment, majority of patients＇ the best corrected visual acuity （BCVA）, fundus and central macular thickness （CMT） were significantly improved, compared with the pre- treatment, the difference is significant （P〈0.05）. So that anti-VEGF drugs can effectively improve visual function and ocular fundus for fundus diseses. There were no serious adverse reactions except 3 patients appearling skin redness, itching, rash, 1 patient low low-grade fever and 1 patient acute cerebral infarction during the treatment. CONCLUSION： Intravitreal anti- VEGF drugs injection can significantly improve the visual function and ocular fundus for patients with fundus diseases, but there are still some adverse events, which should be attached great importance to medical workers.
作者
徐建锋
杨丽君
莫荔
罗瑶琴
吴艺君
叶瑞珍
连晓东
蔡泽煌
Jian-Feng Xu Li-Jun Yang Li Mo Yao-Qin Luo Yi-Jun Wu Rui-Zhen Ye Xiao-Dong Lian Ze- Huang Cai(Department of Ophthalmology, 180th Hospital of the P. L. A. , Quanzhou 362000, Fujian Province, China)
出处
《国际眼科杂志》
CAS
2017年第9期1734-1737,共4页
International Eye Science
基金
2014军区医学科技创新项目(No.14MS094)
泉州市科技创新基金(No.2015Z76)
2014年度医院基金项目(No.2014D3005)~~
关键词
抗VEGF药物
玻璃体腔内注射
眼底疾病
真实世界下
anti- vascular endothelial growth factordrugs
intravitreal injection
fundus diseases
real-world
