抗VEGF药物(雷珠单抗)治疗不同病程湿性年龄相关性黄斑变性62例

目的 观察抗VEGF药物(雷珠单抗)治疗不同病程湿性年龄相关性黄斑变性的临床疗效。方法 临床诊断为湿性年龄相关性黄斑变性患者62例(62眼)纳入研究，分为A、B两组，A组：32眼，病程在6个月内；B组：病程在6～12个月，30眼。所有患者确诊后，每月行玻璃体腔内注入雷珠单抗0.5 mg，连续注药3次，以后根据每月复查情况决定是否需要再次注射。治疗后随访12个月。复查记录患者视力、眼压、眼底及OCT检查，每3个月做一次荧光素眼底血管造影(FFA)检查。A组患者ETDRS视力表平均字母数为(52.36±8.62)个,平均CRT为(334.62±50.26)μm。B组患者ETDRS视力表平均字母数为(36.41±6.73)个，平均CRT为(368.37±40.52)μm。观察两组患者治疗前后视力增加字母数、黄斑中心视网膜厚度(CRT)减少量及两组注药次数比较。结果 患者首次注射后3、6、12个月，A组ETDRS视力表提高字母数分别为(16.82±3.56、17.33±3.47、15.72±4.38)个，B组提高字母数分别为(9.23±2.51、10.22±3.46、8.34±3.51)个，A组首次注射后3、6、12个月提高的字母数分别多于B组提高的字母数，差异有统计学意义(t=9.643,8.074,7.290； P<0.05)。A组首次注射后3、6、12个月CRT减少量分别为(175.86±55.23、168.75±46.38、173.58±35.63)μm，B组CRT减少量分别为(102.34±32.31,93.76±28.73,89.65±27.82)μm，A组首次注射后3、6、12个月CRT减少量分别多于B组减少量，差异有统计学意义(t=6.342,7.593,10.291； P<0.05)。随访至12月时，A组平均注射(4.6±1.7)次，B组平均注射(6.8±2.2)次，差异有统计学意义(t=4.422， P<0.05)。结论 雷珠单抗对病程小于6个月湿性年龄相关性黄斑变性患者的视力提高、黄斑水肿的疗效优于病程6～12月者。早期治疗可减少治疗次数，从而降低治疗成本。

Anti VEGF drugs(lucentis)to treat different courses of wet age-related maculardegeneration (62 cases report)

Objective To observe the effectiveness of lucentise, an anti- VEGF drug, in the treatment of different courses of wet age-related macular degeneration. Methods 62 cases of wet age-related macular degeneration, including 62 eyes, enrolled into the study. According to the courses of disease, 32 eyes were divided into group A (<6 months) and the other 30 eyes in group B (6-12 months). All the patients received intravitreal injection of ranibizumab (0.5 mg)once a month for 3 consecutive months. At the end of each month, assessment were made to determine whether the next injection was necessary. In a 12-month follow-up,FFA examination was performed every three months. For group A, the average number of letters on ETDRS visual acuity chart was (52.36±8.62), and the average CRT was (334.62±50.26) μm. The corresponding results for Group B were (36.41±6.73) and (368.37±40.52) μm. Visual acuity before and after treatment were observed. The number of letters, macular retinal thickness (CRT) and the injection times between the two groups were compared. Results In group A, 3,6,12 months after the first injection,the improvements of the number of letters in ETDRS eye chart were 16.82 ± 3.56,17.33±3.47 and 15.72±4.38, respectively, compared to 9.23±2.51,10.22±3.46 and 8.34±3.51 in group B (t=9.643,8.074,7.290; P<0.05). The decrease of CRT at 3, 6, 12 months after the first injection were 175.86±55.23 μm, 168.75±46.38 μm and 173.58±35.63 μm in group A,compared to 102.34±32.31 μm, 93.76±28.73 μm and 89.65±27.82 μm in group B (t=6.342,7.593,10.291; P<0.05). In the first year of follow-up, the patients in group A were injected 4.6±1.7 times on average, while the number in group B were 6.8±2.2 times (t=4.422, P<0.05). Conclusion Anti-VEGF drugs (lucentise) demonstrates better clinical results on visual acuity improvement and decrease of CRT thickness for wet age-related macular degeneration patients with duration less than six months than those with duration between six to twelve months. Early application of lucentise injection can reduce the injection times and cost for the treatment.