| 光动力疗法联合抗血管内皮生长因子治疗息肉状脉络膜血管病变的效果:基于光学相干断层扫描血管成像(OCTA)的观察 |
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| 引用本文： | 韩珺琳,张桐梅,解世勇,丛春霞,李立,王健,韩梅. 光动力疗法联合抗血管内皮生长因子治疗息肉状脉络膜血管病变的效果:基于光学相干断层扫描血管成像(OCTA)的观察[J]. 眼科新进展, 2019, 0(4): 358-362. DOI: 10.13389/j.cnki.rao.2019.0081 |
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| 作者姓名： | 韩珺琳 张桐梅 解世勇 丛春霞 李立 王健 韩梅 |
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| 作者单位： | 300020 天津市，天津医科大学眼科临床学院，天津市眼科医院，天津市眼科学与视觉科学重点实验室，天津市眼科研究所 |
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| 摘 要： | 目的利用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)及频域光学相干断层扫描(optical cohorence tomography,OCT)评估息肉状脉络膜血管病变(polypoid choroidal vasculopathy,PCV)光动力疗法(photodynamic therapy,PDT)联合抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗后疗效。方法回顾性分析PCV患者46例48眼的临床资料,患眼均行荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)、OCT及OCTA检查,所有患者按照常规剂量先行PDT治疗,3～5 d内再联合抗VEGF治疗,随访3～24个月。分析并比较PCV治疗前后视力、中央视网膜厚度(central retinal thickness,CRT)的变化,以及治疗前后OCTA上息肉病灶、异常分支血管网(branching vascular network,BVN)的变化。结果治疗后3个月、6个月、12个月、24个月患眼视力均提高,CRT均下降。治疗前最佳矫正视力为(0.50±0.40)logMAR,治疗后24个月为(0.44±0.37)logMAR,差异有统计学意义(t=4.452,P<0.05)。治疗前CRT为(601.89±183.88)μm,治疗后24个月CRT厚度为(457.54±207.80)μm,差异有统计学意义(t=5.968,P<0.05)。治疗前48眼中OCTA上息肉病灶检出率70.8%,ICGA上息肉病灶检出率100.0%;34眼联合OCTA检查治疗后3个月、6个月、12个月、24个月息肉病灶完全消退率分别为79.4%、78.8%、75.8%和83.3%。治疗前14眼在OCTA检查中未发现息肉病灶,在联合治疗后复查OCT,治疗后3个月、6个月、12个月、24个月指状突起消退率分别为71.4%、76.9%、75.0%、87.5%。患者联合治疗OCTA上BVN的面积治疗前为(0.916±0.215)mm^2,治疗后3个月、6个月、12个月及24个月分别为(0.823±0.286)mm^2、(0.909±0.312)mm^2、(1.121±0.389)mm^2和(1.672±0.230)mm^2。结论典型的PCV病变在PDT联合抗VEGF治疗后能安全有效地显著改善和稳定患者的视力、降低CRT、促进息肉病灶消退。无创、快速和可重复的OCTA联合OCT可作为联合治疗后评价PCV病情有用的随诊技术。
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| 关 键 词： | 息肉状脉络膜血管病变 光学相干断层扫描血管成像 荧光素眼底血管造影 吲哚菁绿血管造影 |
Observation of photodynamic laser combined with anti-vascular endothelial growth factor in the treatment of polypoidal choroidal vasculopathy with optical coherence tomography |
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| HAN Jun-Lin,ZHANG Tong-Mei,XIE Shi-Yong,CONG Chun-Xia,LI Li,WANG Jian,HAN Mei. Observation of photodynamic laser combined with anti-vascular endothelial growth factor in the treatment of polypoidal choroidal vasculopathy with optical coherence tomography[J]. Recent Advances in Ophthalmology, 2019, 0(4): 358-362. DOI: 10.13389/j.cnki.rao.2019.0081 |
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| Authors: | HAN Jun-Lin ZHANG Tong-Mei XIE Shi-Yong CONG Chun-Xia LI Li WANG Jian HAN Mei |
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| Affiliation: | Clinical College of Ophthalmology，Tianjin Medical University，Tianjin Eye Hospital，Tianjin Key Lab of Ophthalmology and Visual Science，Tianjin Eye Institute，Tianjin 300020，China |
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| Abstract: | Objective To analyze the importance of optical coherence tomography angiography （OCTA） combining with spectral domain optical coherence tomography （OCT） for evaluating efficacy of photodynamic therapy （PDT） with intravitreal anti-vascular endothelial growth factor for patients with polypoidal choroidal vasculopathy （PCV）.Methods A total of 46 PCV patients （48 eyes） were included in this retrospective study.All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography （FFA），indocyanine green angiography （ICGA），OCT and OCTA.All patients were treated with conventional doses of PDT at first，and then combined with anti-vascular endothelial growth factor treatment within 3-5 days，with follow-up for 3-24 months.Analysis and comparison of mean visual acuity and mean central retinal thickness （CRT） before and after PCV treatment.The changes of branching vascular network （BVN） and polyps on OCTA were compared between before and after treatment.Results The visual acuity improved at 3，6，12，and 24 months after treatment，and CRT decreased.The visual acuity before treatment was （0.50±0.40）logMAR，and the visual acuity at 24 months after treatment was （0.44±0.37）logMAR.The difference between the two groups was statistically significant （t=4.452，P<0.05）.The CRT before treatment was （601.89±183.88）μm，and the CRT thickness at 24 months after treatment was （457.54±207.80）μm.The difference between the two groups was statistically significant （t=5.968，P<0.05）.The detection rate of polys on OCTA was 70.8%，and the detection rate of BVN was 100%.The complete regression rates of polyps at 3，6，12，and 24 months after combined treatment were 79.4%，78.8%，75.8%，and 83.3%，respectively.Before treatment，14 eyes had no polys in OCTA examination.OCT was reviewed after combination therapy.The regression rate of finger neurites was 71.4%，76.9%，75.0%，and 87.5% at 3，6，12，and 24 months after treatment，respectively.The area of BVN on OCTA before combined treatment was （0.916±0.215）mm2，and the areas at 3 months，6 months，12 months and 24 months after the treatment were （0.823±0.286）mm2，（0.909±0.312）mm2，（1.121±0.389）mm2 and （1.672±0.230）mm2，respectively.Conclusion Typical PCV lesions can significantly and effectively improve and stabilize the visual acuity of PCV patients，reduce CRT，and promote polys regression after PDT combined with anti-VEGF therapy.Non-invasive，rapid and repeatable OCTA combined with OCT can be used as a useful follow-up technique for evaluating PCV conditions after combination therapy. |
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| Keywords: | polypoid choroidal vasculopathy optical coherence tomography angiography fundus fluorescein angiography indocyanine green angiography |
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