[1]胡军平,杨华,李国栋,等.光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变[J].眼科新进展,2015,35(11):1039-1043.[doi:10.13389/j.cnki.rao.2015.0284]
　HU Jun-Ping,YANG Hua,LI Guo-Dong,et al.Macular visual field changes after combined photodynamic therapy and intravitreal injection of ranibizumab for neovacular age-related macular degeneration[J].Recent Advances in Ophthalmology,2015,35(11):1039-1043.[doi:10.13389/j.cnki.rao.2015.0284]
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光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
35卷
期数:
2015年11期
页码:
1039-1043
栏目:
应用研究
出版日期:
2015-11-05

文章信息/Info

Title:
Macular visual field changes after combined photodynamic therapy and intravitreal injection of ranibizumab for neovacular age-related macular degeneration
作者:
胡军平; 杨华; 李国栋; 陈静; 李冬莉; 蔡宁; 龚翊; 庞文毅; 袁玲
650032　云南省昆明市，昆明医科大学第一附属医院眼科
Author(s):
HU Jun-Ping; YANG Hua;  LI Guo-Dong ;  CHEN Jing ;  LI Dong-Li; CAI Ning; GONG Yu ;  PANG Wen-Yi; YUAN Ling
Department of Ophthalmology , the First Affiliated Hospital of Kunming Medical University , Kunming 650032 , Yunnan Province . China
关键词:
年龄相关性黄斑变性; 光动力疗法; 雷珠单抗; 视野
Keywords:
age-related macular degeneration ;  photodynamic therapy;  ranibizumab ;  visual field
DOI:
10.13389/j.cnki.rao.2015.0284
文献标志码:
A
摘要:
目的　评价光动力疗法（ｐｈｏｔｏｄｙｎａｍｉｃｔｈｅｒａｐｙ，ＰＤＴ）联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性（ａｇｅ-ｒｅｌａｔｅｄｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎＡＭＤ）后患者黄斑区中心视野的变化情况。方法　本研究纳入湿性ＡＭＤ患者２６例（２８眼），每例患者予以１次维替泊芬联合ＰＤＴ后３ｄ再给予玻璃体内注射雷珠单抗治疗，然后根据患者治疗后１个月、３个月、６个月的最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ）、Ｈｕｍｐｈｒｅｙ１０-２中心视野检查、黄斑中心凹厚度（ｃｅｎｔｒａｌｆｏｖｅａｌｔｈｉｃｋｎｅｓｓ，ＣＦＴ）、眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）及吲哚青绿血管造影（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｅｎａｎｇｉｏｇｒａｐｈｙ，ＩＣＧＡ）的渗漏情况决定是否需要再次玻璃体内注射雷珠单抗。结果　联合治疗后１个月、３个月、６个月，湿性ＡＭＤ患者的ＢＣＶＡ明显提高，分别为０．２２±０．０７、０．２６±０．０７、０．２４±０．０８（Ｐ＝０．０２９、０．００４、０．０１５），而治疗前ＢＣＶＡ为０．１２±０．０９；ＣＦＴ显著降低，分别为（２６４．０９±２８．４０）μｍ、（２７３．４５±２４．８９）μｍ、（２８６．５４±２６．３９）μｍ（均为Ｐ＝０．０００），而治疗前ＣＦＴ为（４５８．２７±２７．３８）μｍ；中心视野１０°范围内的平均敏感度（ｍｅａｎｓｅｎｓｉｔｉｖｉｔｙ，ＭＳ）增加了，分别为（２４．３３±３．２０）ｄＢ、（２４．５４±３．２５）ｄＢ、（２６．８９±３．４６）ｄＢ（Ｐ＝０．０１５、０．０１０、０．０００），而治疗前的ＭＳ为（２０．２５±３．１２）ｄＢ；４°范围内ＭＳ增加了，分别为（２３．６６±４．２３）ｄＢ、（２３．４０±４．４９）ｄＢ、（２５．９３±４．４３）ｄＢ（Ｐ＝０．０２４、０．０３４、０．００１），而治疗前４°范围内ＭＳ是（１９．４９±４．６６）ｄＢ；视野平均缺损（ｍｅａｎｄｅｖｉａ-ｔｉｏｎ，ＭＤ）降低了，分别为（－７．６０±３．２４）ｄＢ、（－７．７２±３．５１）ｄＢ、（－６．２９±３．２１）ｄＢ（Ｐ＝０．００８、０．０１０、０．００１），而治疗前ＭＤ为（－１１．９８±３．１８）ｄＢ。模式标准差增加了，分别是５．４４±１．５３、５．７８±１．８２、６．８８±１．６５（Ｐ＝０．０１３、０．００４、０．０００），而治疗前模式标准差为３．３４±１．０４。所有的数据均提示黄斑区的功能有好转。此外，ＢＣＶＡ和ＣＦＴ（ｒ＝－０．２９７，Ｐ＝０．００５）、ＣＦＴ和中心视野１０°范围内的ＭＳ（ｒ＝－０．３８５，Ｐ＝０．０００）、ＣＦＴ和视野的ＭＤ（ｒ＝－０．１９３，Ｐ＝０．０３３）两两之间存在一定的负相关关系。结论　黄斑区中心Ｈｕｍｐｈｒｅｙ视野指数的改变可用于评估ＰＤＴ联合玻璃体内注射雷珠单抗治疗湿性ＡＭＤ后患者视功能的改变。
Abstract:
Objective To evaluate the macular visual field changes in patients with neovascular age-related macular degeneration ( AMD ) after combined photodynamic therapy( PDT) and intravitreal injection of ranibizumab. Methods Twenty-eight eyes of 26 patients with neovascular AMD were recruited in this prospective ,interventional study. Each patient was treated with one session of PDT and one intravitreal injection of ranibizumab 3 days later. Retreatment with intravitreal injection of ranibizumab was performed according to predefined criteria. Best corrected visual acuity ( BCVA) , 10-2 Humphrey visual field testing , central foveal thickness( CFT) , leakage on fundus fluorescence angiography ( FFA) and indocyanine green angiography( ICGA) were compared between baseline and I month . 3 months and 6 months after the combined treatment. Results Compared with before treatment( BCVA :0. 12 +0. 09 ) , BCVA was significantly improved at I months.3 months and 6 months after treatment . which were 0. 22 +0. 07 ( P = 0. 029 ) ,0. 26 + 0. 07 ( P = 0. 004) and 0. 24 + 0. 08 ( P = 0. 015 ) , respectively. Compared with before treatment (458. 27 + 27. 38) Vm,CFT was significantly reduced at I month,3 months and 6 months after treatment . which were ( 264. 09 + 28. 40 ) ym ( P = 0. 000 ) . ( 273. 45 + 24. 89) Vm(P = 0. 000 ) and ( 286. 54 + 26. 39 ) ym (P = 0. 000) , respectively. Compared with before treatment( 20. 25 + 3. 12 ) dB , visual field parameters 100 MS was significantly improved at I month.3 months and 6 months after treatment. which were ( 24. 33 +3. 20) dB(P = 0. 015 ) , ( 24. 54 +3. 25 ) dB(P = 0. 010 ) and ( 26. 89 +3. 46 ) dB ( P = 0. 000 ) , respectively. Compared with before treatment ( 19. 49 + 4. 66 ) dB , visual field parameters 40 MS was significantly improved at I month, 3 months and 6 months after treatment , which were ( 23. 66 +4. 23 ) dB ( P = 0. 024 ) , ( 23. 40 + 4. 49 ) dB (P = 0. 034 ) and ( 25. 93 +4. 43 ) dB ( P = 0. 001 ) , respectively. Compared with before treatment ( - 11. 98 + 3. 18 ) dB , MD was significantly improved at I month, 3 months and 6 months after treatment , which were ( - 7. 60 + 3. 24 ) dB ( P = 0. 008 ) . - 7. 72 + 3. 51 ) dB ( P = 0. 010 ) and ( - 6. 29 + 3. 21 ) dB (P = 0. 001) , respectively. And compared with before treatment( 3. 34 + 1. 04 ) , PSD was sigruficantly improved at I month.3 months and 6 months after treatment. which were 5. 44 + 1. 53 (P = 0. 013 ) ,5. 78 + 1. 82 (P = 0. 004 ) , and 6. 88 + 1. 65 (P = 0. 000) , respectively. There was modest negative correlation between BCVA and CFT ( r = - 0. 297 .P = 0. 005 ) . CFT and IOoMS( r = - 0. 385 .P = 0. 000 ) .CFT and MD( r = - 0. 193 .P = 0. 033 ) . Conclusion Macular visual field improvement can be achieved by combined PDT and intravitreal injection of ranibizumab. Central macular visual field may be useful in evaluating treatment efficacy in neovascular AMD patients.

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备注/Memo

备注/Memo:
国家自然科学基金资助（编号：８１２６０１５１）；云南省科技厅应用基础研究面上项目（编号：２０１１ＦＢ０６２）
更新日期/Last Update: 2015-11-03