【摘要】 目的观察玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗特发性脉络膜新生血管(ICNV)的临床效果及影响其预后的相关因素。方法收集2012年1月至2013年6月北京大学第三医院眼科中心40例(40只眼)ICNV患者的临床资料,进行回顾性分析。所有患者经间接检眼镜检查、荧光素眼底血管造影(FFA)检查、吲哚菁绿血管造影(ICGA)检查及光学相干断层扫描(OCT)检查确诊为ICNV。对所有患者行玻璃体腔注射抗VEGF药物进行治疗,注药次数1~4次,平均(2.5±0.72)次。术后患者复诊1次/月,在复诊时经OCT检查发现病变部位仍存在视网膜下积液者重复注射。手术前后患者的最佳矫正视力(BCVA)和平均视网膜厚度(CRT)以均数±标准差(x珋±s)的形式表示,并采用配对t检验的方法进行比较;患者的年龄、病程、CNV位置、玻璃体腔注射次数、术前BCVA、术前CRT及玻璃体腔注射药物种类与术后6个月BCVA的相关系数采用多元线性回归分析的方法表示,并采用秩和检验的方法进行比较;患者玻璃体腔注射药物的种类及CNV位置采用χ2检验的方法进行比较。结果术前患者平均BCVA为(55.30±18.19),术后6个月患者平均BCVA为(76.45±13.03),手术前后比较,差异有统计学意义(t=-5.42,P<0.05)。术前患者的CRT为(359.10±135.28)μm,术后6个月患者的CRT为(280.00±79.65)μm,手术前后比较,差异有统计学意义(t=-4.73,P<0.05)。术后6个月BCVA提高≥15个字母者24例(24只眼),占60.00%;BCVA提高<15个字母者16例(16只眼),占40.00%,无BCVA下降者。术后6个月患者的BCVA与病程、术前BCVA及术前CRT等因素相关,差异有统计学意义(r=-0.131,0.433,-0.028;P<0.05)。与患者的年龄、CNV位置、玻璃体腔注射次数及玻璃体腔注射药物种类等因素无关,差异无统计学意义(r=-0.149,0.036,0.099,0.089;P>0.05)。将患者进一步根据病程分为病程≤4周组27例(27只眼)与病程>4周组13例(13只眼)。病程≤4周组患者年龄为(32.85±7.50)岁,玻璃体腔注射次数(2.48±0.75)次,术前BCVA为(57.96±16.83);病程>4周组患者年龄为(35.38±10.70)岁,玻璃体腔注射次数为(2.53±0.66)次,术前BCVA为(49.77±20.31),两组比较,差异无统计学意义(t=0.51,0.43,1.48;P>0.05)。病程≤4周组患者术前CRT为(80.04±5.58)μm,术后6个月CRT为(270.93±65.87)μm,术后6个月BCVA为(338.74±79.53);病程>4周组患者术前CRT为(69.00±19.88)μm,术后6个月CRT为(298.85±103.19)μm,术后6个月BCVA为(401.38±207.12),两组比较,差异有统计学意义(t=-0.20,-2.60,-1.64;P<0.05)。病程≤4周组,CNV位置在中心凹下的患者13例(13只眼),占48.15%;CNV位置接近中心凹的患者14例(14只眼),占51.85。病程>4周组,CNV位置在中心凹下的患者3例(3只眼),占23.07%;CNV位置接近中心凹的患者10例(10只眼),占76.93%。两组比较,差异无统计学意义(χ2=1.61,P>0.05)。病程≤4周组,患者中玻璃体腔注射兰尼单抗者13例(13只眼),占48.15%;注射贝伐单抗者14例(14只眼),占51.58%。病程>4周组,患者中玻璃体腔注射兰尼单抗者5例(5只眼),占38.46%;注射贝伐单抗者8例(8只眼),占61.54%。两组比较,差异无统计学意义(χ2=0.002,P>0.05)。术后所有患者未发生全身并发症,眼局部有小范围结膜下出血者3例(3只眼),占7.50%,未见其他并发症发生。结论抗VEGF药物治疗ICNV的疗效明显,尤其对于病程较短(4周内)、术前视力较好的患者,可降低患眼视网膜厚度,明显提高患者的视力。更多还原

【Abstract】 Objective To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor( VEGF) in the treatment of idiopathic neovascularization( ICNV). Methods This retrospective study Involved 40 patients( 40 eyes) with ICNV diagnosed based on the results from indirect ophthalmoscopy,fundus fluorescein angiography( FFA),ICG angiography( ICGA) and optical coherence tomography( OCT).ICNV was subfoveal in 16 eyes and juxtafoveal in 24 eyes. Patients received 1-4 doses of intravitreal ranibizumab( n = 18) or intravitreal bevacizumab( n = 22). Data on the best corrected visual acuity( BCVA),OCT and central retinal thickness( CRT) after treatment were retrieved and analyzed. Correlations between the post-treatment BCVA and other parameters were tested. Results The average BCVA was( 55. 3 ± 18. 19) prior to treatment and( 76. 45 ± 13. 03) at 6 months after treatment( P < 0. 05). CRT was( 359. 1 ± 135. 28) μm prior to treatment and( 80. 00 ± 79. 65) μm at 6 months after treatment( P < 0.05). The BCVA at 6 months after treatment was significantly correlated negatively with the disease course( r=- 0. 131,P < 0. 05) and positively with the baseline BCVA prior to treatment( r = 0. 433,P < 0. 05) and CRT( r = 0. 028,P < 0. 05),but not significantly correlated with patient age( r =- 0. 149,P > 0. 05),ICNV location( r = 0. 036,P > 0. 05),number of anti-VEGF injections( r = 0. 099,P > 0. 05) and type of antiVEGF agent( ranibizumab or bevacizumab,r = 0. 089,P > 0. 05). No severe systemic complications were observed during the follow-up period. Conclusion Intravitreal injection of anti-VEGF agents may improve visual acuity and reduce central retinal thickness in patients with ICNV,thus having great therapeutic potential.更多还原