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玻璃体腔注射小剂量更昔洛韦治疗获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的疗效观察
引用本文:梁雪梅,陈善平,尹瑰娜. 玻璃体腔注射小剂量更昔洛韦治疗获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的疗效观察[J]. 中华眼底病杂志, 2020, 0(4): 280-284
作者姓名:梁雪梅  陈善平  尹瑰娜
作者单位:南宁爱尔眼科医院
摘    要:
目的:观察小剂量更昔洛韦玻璃体腔注射(IVTG)治疗获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的临床疗效和安全性。方法:前瞻性临床研究。2016年1月至2018年1月于南宁爱尔眼科医院眼底病专科就诊的AIDS合并CMVR患者15例28只眼纳入研究。28只眼中,BCVA手动~数指者6只眼(21.4%);0.02~0.1者15只眼(53.6%);>0.1者7只眼(25.0%)。所有患眼均给予IVTG 0.1 ml(含更昔洛韦0.4 mg)治疗,诱导期2次/周,共4次;维持期1次/周,直至病灶完全消退或瘢痕化。平均IVTG次数为(7.1±1.7)次。无更昔洛韦全身使用禁忌症且住院患者给予全身静脉注射更昔洛韦(IVG)5.0 mg/(kg·d),共2周。根据不同治疗方案将患者分为IVTG组、IVTG+IVG组,分别为5例8只眼和10例20只眼。治疗后随访时间≥6个月。观察BCVA、病灶稳定或消退以及并发症发生情况。结果:治疗后6个月,28只眼前房及玻璃体炎症均明显减轻或消失;视网膜病灶稳定或消退20只眼(71.4%)。BCVA提高者24只眼,稳定者4只眼。BCVA≤数指者2只眼(7.1%),0.02~0.1者7只眼(25.0%),>0.1者19只眼(67.9%);与治疗前比较,BCVA≤数指、0.02~0.1者百分率降低,BCVA>0.1者百分率提高。IVTG+IVG组、IVTG组患眼病灶稳定或消退时间分别为(83.2±25.2)、(85.3±24.4)d;病灶消退或稳定时间比较,差异无统计学意义(Z=0.17,P=0.87)。两组患眼病灶稳定或消退者分别为15(75.0%)、5(62.5%)只眼;病灶消退率比较,差异无统计学意义(F=0.42,P=0.51)。随访期间所有患眼CMVR无复发,单眼患者对侧眼未出现CMVR;未出现眼内炎、玻璃体积血、视网膜脱离等与治疗方式相关的严重并发症。结论:小剂量IVTG治疗AIDS合并CMVR安全、有效。

关 键 词:获得性免疫缺陷综合征/并发症  巨细胞病毒性视网膜炎/药物疗法  更昔洛韦/治疗应用  治疗结果

Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis
Liang Xuemei,Chen Shanping,Yin Guina. Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis[J]. Chinese Journal of Ocular Fundus Diseases, 2020, 0(4): 280-284
Authors:Liang Xuemei  Chen Shanping  Yin Guina
Affiliation:(Nanning Aier Eye Hospital,Nanning 530003,China)
Abstract:
Objective To evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome(AIDS)patients with cytomegalovirus retinitis(CMVR).Methods A prospective observational cohort study observed 15 AIDS patients(28 eyes)who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital.Among this 28 eyes,BCVA of 6 eyes(21.4%)were between moving hand to counting finger,15 eyes(53.6%)were between 0.02 to 0.1 and 7 eyes were better than 0.1(25.0%).All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml(contain ganciclovir 0.4 mg).The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly.The mean number of injections was 7.1±1.7 times.For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir(IVG)5.0 mg/kg·d until complete resolution of CMVR.All patients were divided into intravitreal ganciclovir(IVTG)group and IVTG+IVG group according to different treatment plans,which were 5 cases with 8 eyes and 10 cases with 20 eyes,respectively.The follow-up was more than 6 months.BCVA,complete resolution or stable of the lesion and complications were observed.Results Six months later,20 eyes(71.4%)had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation,and the retinal lesions became stable or complete resolution.24 eyes showed improvements of BCVA and 4 eyes showed stable.2 eyes(7.1%)presented with BCVA≤counting finger,7 eyes(25.0%)were 0.02-0.1 and 19 eyes were≥0.1(67.9%).Compared with before treatment,the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased(21.4%vs 7.1%and 53.6%vs 25.0%,respectively),but the ratio of BCVA better than 0.1 increased(25.0%vs 67.9%).When IVTG+IVG group was compared with IVTG group,the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively.There was no significant difference in resolution times(Z=0.17,P=0.87).The ratio of retinal lesions became stable or complete resolution were 75.0%(15 eyes)and 62.5%(5 eyes),there was no evident difference in time-to-resolution between the two groups(F=0.42,P=0.51).No recurrence was seen during the follow-up period.In cases of unilateral CMVR,there were no patients with a second eye involvement during the follow-up period.No endophthalmitis,vitreous hemorrhage,retinal detachment were found in our study.Conclusion Reduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
Keywords:Acquired immunodeficiency syndrome/complications  Cytomegalovirus retinitis/drug therapy  Ganciclovir/therapeutic use  Treatment outcome
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