摘要
目的观察光动力疗法(PDT)联合玻璃体腔注射雷珠单抗(IVR)治疗视网膜血管瘤样增生(RAP)伴视网膜色素上皮脱离(PED)的临床效果。方法9例(16眼)RAP伴PED患者,所有患者均行最佳矫正视力(BCVA)检查、裂隙灯眼前节检查、复方托吡卡胺散瞳后眼底检查、眼压、经荧光素眼底血管造影术(FFA)、吲哚菁绿血管造影(ICGA)及光学相干断层扫描(OCT)检查。比较患者治疗前后BCVA、PED高度、PED容积、病变最厚处视网膜厚度(MRT)。结果治疗后患者最小分辨角对数(logMAR)BCVA为(0.70±0.19),与治疗前的(0.79±0.38)比较,差异无统计学意义(t=0.847,P>0.05)。16只患眼,术后视力提高9眼,视力稳定5眼,视力下降2眼,视力不提高眼数中71.4%(5/7)的患者是PED范围>病变面积50%的患者。患者治疗后PED完全消失3眼;PED高度及容积明显缩小11眼;PED高度及容积无明显变化2眼,其中1眼为PED范围达病变面积的76.3%,1眼为出血性PED。治疗后患者PED高度为(246.56±175.18)μm、PED容积为(0.907±0.71)mm^3,均小于治疗前的(396.20±161.23)μm、(1.735±0.97)mm^3,差异具有统计学意义(t=2.514、2.755,P<0.05)。治疗后患者16眼的MRT为(277.23±101.89)μm,低于治疗前的(351.34±102.09)μm,差异有统计学意义(t=2.055,P<0.05)。结论PDT联合IVR治疗RAP伴PED,能安全有效降低PED高度,减少PED容积,降低MRT。但患者术后视力提高与否则取决于PED病变程度,当PED范围<病灶范围50%时,联合治疗能有效提高术后视力;当PED范围≥病灶范围50%时,联合治疗亦不能改善患者视力。
Objective To observe the clinical effect of photodynamic therapy(PDT)combined with intravitreal injection of ranibizumab(IVR)in the treatment of retinal angiomatous proliferation(RAP)with pigment epithelial detachment(PED).Methods 9 patients(16 eyes)with RAP and PED all underwent best corrected visual acuity(BCVA),slit lamp anterior segment examination,fundus examination after compound tropicamide mydriasis,intraocular pressure,fundus angiography(FFA),indocyanine green angiography(ICGA)and optical coherence tomography(OCT).The BCVA,PED height,PED volume,and macular retinal thickness(MRT)at the thickest part of the lesion were compared before and after treatment.Results After treatment,the logarithm of minimum resolution angle(LogMAR)BCVA was(0.70±0.19),which was significantly higher than(0.79±0.38)before treatment,and the difference was not statistically significant(t=0.847,P>0.05).Among the 16 eyes,the visual acuity was improved in 9 eyes,stable in 5 eyes,and decreased in 2 eyes,and 71.4%(5/7)of the patients whose visual acuity did not improve were those with PED range>50%of lesion area.After treatment,PED disappeared completely in 3 eyes;PED height and volume were significantly reduced in 11 eyes;PED height and volume did not change significantly in 2 eyes,of which 1 eye had PED range of 76.3%of the lesion area,and 1 eye had hemorrhagic PED.After treatment,the patient’s PED height was(246.56±175.18)μm,and the PED volume was(0.907±0.71)mm^3,both of which were smaller than the(396.20±161.23)μm and(1.735±0.97)mm^3 before treatment,and the difference was statistically significant(t=2.514,2.755,P<0.05).After treatment,the MRT of 16 eyes of patients was(277.23±101.89)μm,which was lower than(351.34±102.09)μm before treatment,and the difference was statistically significant(t=2.055,P<0.05).Conclusion PDT combined with IVR can safely and effectively reduce the height and volume of PED as well as MRT of patients with RAP and PED.However,the improvement of postoperative visual acuity depends on the degree of PED lesions.When the PED range<50%,the combined treatment can effectively improve the postoperative visual acuity;when the PED range≥50%of the lesion range,the combined treatment can not improve the visual acuity of the patients.
作者
张聪
许贺
ZHANG Cong;XU He(Shenyang Fourth People’s Hospital,Shenyang 110031,China)
出处
《中国现代药物应用》
2020年第22期20-22,共3页
Chinese Journal of Modern Drug Application
关键词
视网膜血管瘤样增生
色素上皮脱离
光动力疗法
雷珠单抗
Retinal angiomatous proliferation
Pigment epithelial detachment
Photodynamic therapy
Ranibizumab
