玻璃体腔注射Avastin治疗特发性脉络膜新生血管的临床观察

目的 观察玻璃体腔沣射Avastin治疗特发性脉络膜新生血管的临床疗效和安全性.方法 对玻璃体腔注射Avastin治疗特发性脉络膜新生血管16例16只跟进行回顾分析.对比分析治疗前后LogMAR最佳矫正视力(Best corrected visual acuity,BCVA)、光学相干断层扫描(optical coherence tomography ,OCT)、吲哚青绿血管造影(indocyanine green angiography,ICGA)等检查结果.在随访中如有复发者给予重复注药.结果 16例年龄25～42岁,平均(34.50±5.00)岁,随访8～96周,平均(51.50±27.29)周.术前BCVAO～1.69(0.59±0.44),所有病例视力在术后一周时开始提高,4周后趋于稳定,末次随访视力提高1行者1例(6%),3行2例(13%),6行以上者12例(75%),视力无提高但症状改善者1例(6%).术前OCT检查黄斑中心厚度(mean central retinal thickness,CMT)为160～455(291.33±91.72)μm,术后1、2、4、8周及末次CMT分别为152～396(259.67±78.07)μm、123～365(210.50±72.73)μm、1 15～333(167.17±57.56)μm、109～333(151.50±60.13)μm、101～337(150.67±61.95)μm.所有病例在术后一周黄斑区水肿、出血明显消失;治疗后第2个月复查ICGA显示脉络膜新生血管均静止.本组有3例因脉络膜新生血管(CNV)复发,予光动力疗法,并蓖复注射Avastin 1次,其余13例随访期间未见CNV复发.注药前后眼压变化无统计学意义.随访中无全身和眼部并发症发生.结论 玻璃体腔注射Avastin治疗能使脉络膜新生血管迅速消退,较快地提高视力,明显缩短病程,改善预后,且无严重并发症.但其长期疗效和并发症仍需进一步观察.

Intravitreal Avastin for idiopathic choroidal neovascularization

Objective To evaluate the safety and effectiveness of intravitreal Avastin injection as a treatment option for idiopathic choroidal neovascularization (CNV).Methods Of 16 eyes of 16 patients who were treated with intravitreal Avastin (1.50 mg/0.06 mL) injection were analyzed retrospectively.Injection was repeated if optical coherence tomography showed intraretinai edema,subretinal fluid,and/or pigment epithelial detachment at a 4-week interval.Ophthalmic evaluations included best-corrected visual acuity,optical coherence tomography (OCT),and lndocyanine green angiography (ICGA).Patients were followed up for at least 8 weeks.Results Patients ranged in age from 25 to 42 years old.The mean follow-up period was 51.50±27.29 weeks.The BCVA at 1 week improved and began to stabilize at the 4-week follow-up,At the last follow-up,14 eyes (88%) had an improvement of best-corrected visual acuity of 3 or more lines,1 eyes (6%)improved 1 line,and 1 eye (6%) remained stable.At the 1-week,2-week,4-week,8-week and the last follow up,mean central retinal thickness decreased from 160-455 (291.33±91.72) μm at baseline to 152-396 (259.67±78.07) μm,123～365 (0.50±72.73) μm,115～333 (167.17±57.56) μm,109～333 (151.50±60.13) μm,101～337 (150.67±61.95) μm.The exudative retinopathy and macular edema completely regressed at the 1 week follow-up.ICGA showed that CNV were static at the 2-month follow-up.Three eyes needed one re-injection and Photodynamic therapy with verteporfin during follow-up at the 3 months because of the recurrence of CNV,and leakage from CNV had ceased in other 13 eyes at the follow-up period.No ocular or systemic adverse reactions were noted.Conclusions Intravitreal Avastin treatment is efficacious in idiopathic choroidal neovascularization and leads to reduction of macular edema and stabilization or improvement in visual acuity.However,further study is necessary to assess the efficacy and safety in the long term.