光动力联合玻璃体腔注射Avastin治疗病理性近视脉络膜新生血管后视功能变化

摘要

目的 观察单独光动力疗法(PDT)及单次PDT联合玻璃体腔注射Avastin治疗病理性近视(PM)脉络膜新生血管(CNV)的疗效.方法 回顾性系列病例研究.经荧光素眼底血管造影(FFA)/吲哚青绿血管造影(ICGA)及光学相干断层扫描(OCT)确诊为PM继发黄斑区CNV,且CNV处于活动期患者38例(38眼)纳入本研究.非随机分组行单独PDT及单次PDT联合玻璃体腔注射Avastin治疗,其中单独PDT治疗组21例(21眼),单次PDT联合玻璃体腔注射Avastin治疗组17例(17眼).治疗前利用糖尿病视网膜病变早期治疗研究(ETDRS)视力表检查患者可读取的字母数,微视野计(MP-1)检查黄斑区中心20°平均光敏感度(MS),OCT测量黄斑中心凹视网膜神经上皮层厚度.治疗后1、3、6个月随访,检查眼底并对比两组治疗前后及两组之间可读取字母数、黄斑中心凹神经上皮层厚度及MS值.若CNV再次渗漏,则需重复治疗.采用独立样本t检验及配对t检验进行分析.结果 治疗后6个月,单独PDT治疗组及单次PDT联合玻璃体腔注射Avastin治疗组可读取字母数、黄斑中心凹视网膜厚度及MS较治疗前有显著改善,差异有统计学意义(单独PDT治疗组:=-4.45、10.72、-8.62,P＜0.01;单次PDT联合玻璃体腔注射Avastin治疗组:t=-9.28、8.72、-11.54,P＜0.01).治疗后1、3、6个月,两治疗组间可读取字母数及黄斑中心凹视网膜厚度比较差异无统计学意义(P＞0.05);单次PDT联合玻璃体腔注射Avastin治疗组MS值高于单独PDT治疗组,差异有统计学意义(t=-2.86、-2.15、-2.50,P＜0.05).结论 单次PDT联合玻璃体腔注射Avastin治疗较单独PDT治疗能稳定、改善PM性CNV患者视网膜敏感度,但需随机、大样本研究证实.%Objective To observe the changes in visual function after photodynamic therapy (PDT) and PDT combined with an intravitreal injection of Avastin for macular choroidal neovascularization (CNV) secondary to pathological myopia (PM).Methods Thirty-eight patients (38 eyes) with active CNV secondary to PM were included in a retrospective case series study.Twentyone patients (21 eyes) were treated with PDT (PDT group),while 17 patients (17 eyes) were treated with PDT combined with an intravitreal injection of Avastin (1.25 mg) (combination group).All patients were assessed by an early treatment of diabetic retinopathy study (ETDRS) chart,optical coherence tomography (OCT) and MP-1 microperimetry before and 1,3,and 6 months after treatment.Results were recorded and compared for the number of recognized letters,foveal nerve fiber layer thickness and macular median sensitivity (MS) within a central 20° area.Treatments were repeated if CNV leaked again.Data were analyzed using independent samples t test and paired t test.Results Six months after treatments,the numbers of recognized letters had increased,foveal retinal thickness had decreased and MS had increased in both the PDT group and combination group,and the differences were statistically significant (PDT group:t=-4.45,10.72,-8.62,P＜0.01; combination group:t=-9.28,8.72,-11.54,P＜0.01).In the following month (7 months after treatment),the differences in the number of recognized letters and foveal nerve fiber layer thickness were not statistically significant between the PDT group and combination group (P＞0.05),while the differences in MS were statistically significant (t=-2.86,-2.15,-2.50,P＜0.05).Conclusion PDT combined with an intravitreal injection of Avastin could effectively stabilize and improve the macular median sensitivity for CNV secondary to PM.