抗血管内皮生长因子单克隆抗体Ranibizumab治疗渗出型老年性黄斑变性临床观察

目的 观察抗血管内皮生长因子单克隆抗体Ranibizumab(Lucentis)玻璃体腔注射治疗渗出型老年性黄斑变性（AMD）的临床疗效和安全性。 方法 回顾分析以糖尿病早期治疗研究(ETDRS)视力表、彩色眼底像、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA ）、光相干断层扫描（OCT）等检查确诊的渗出型AMD 56只眼，采用玻璃体腔注射Ranibizum ab 0.5 mg的方法进行治疗的临床随访资料。治疗前56只患眼ETDRS视力表字母数为25.1个 ，FFA和（或）ICGA检查均有脉络膜新生血管（CNV）渗漏，OCT检查视网膜厚度平均为303.45 μm。Ranibizumab注射治疗次数2～8次，平均治疗次数为3.1次。治疗后随诊时间6～12个月，平均随诊时间8.7个月。回顾分析时，对比分析患者治疗前以及治疗后1、3、6、9、12个月的视力 （ETDRS字母数）、视网膜厚度、CNV病灶渗漏情况以及手术并发症。 结果 56只眼治疗后末次随诊检查时，ETDRS视力表字母数平均为38.5个，字母数较治疗前提高13.4个（t=-3.193，P＜0.01）。其中，视力提高≥15个字母数者22只眼，占39.3%；视力下降>15个字母数者2只眼，占3.6% 。 视网膜厚度平均为191.35 μm，较治疗前下降112.1 μm （t=5.193，P＜0.01）。 CNV渗漏停止者12只眼，占21.4%；渗漏减少者33只眼，占58.9%；无明显改变者9只眼，占16.1%；新发生病灶1只眼，占1.8%。治疗后5只眼有短暂视物模糊，3只眼有轻度眼压升高等不良反应 ，均在1周内消失。 结论 Ranibizumab玻璃体腔注射治疗渗出型AMD可使视力提高，视网膜水肿明显减轻，CNV病灶渗漏停止或减少，安全性高。(中华眼底病杂志，2008，24：160-163)

Clinical observation of intravitreal injection of Ranibizumab for exudative age-related macular degeneration

Objective To observe the efficacy and safety of intravitreal injection of Ranibizumab (Lucentis)on exudative age-related macular degeneration(AMD). Methods To analyze retrospectively the clinicaI data of 56 patients with exudative AMD,which was diagnosed by examination of ETDRS charts,color fundus photograph,fluorescein angiography(FFA)or indocyanine green angiography(ICGA)and optical coherence tomography(OCT),were underwent intravitreal injection Lucentis0.5 mg.Before the treatment,the ETDRS charts letter of 56 eyes was 25.1;choroidal neovascularization(CNA)was leaky which examined by FFA and ICGA I the average thickness of retina was 303.45 μm.Ranibizumab injection therapeutic times were 2-8,the average therapeutic times were 3.1.Follow-up time was 6-12 months(mean 8.7 months).Visual acuity(ETDRS charts letter),retinaI thickness,leakage of CNV and operative complications before and after the treatment were analyzed. Results At the end of the followup period,the mean lciter of ETDRS charts was 38.5,increased 13.4 letters(P＜0.01),the ETDRS charts improved 15 or more letters in 22 eyes(39.3%),decreased more than 15 letters in 2 eyes(3.6%);the foveal thickness on OCT images were 303.4 5μm before treatment and 191.35μm after treatment,decreased significantly(P＜0.00);FFA and/or ICGA showed CNV complete closure in 12 eyes(21.4%),partial closure in 33 eyes(58.9%),no change in 9 eyes(16.1%)and new CNV in 1 eye(1.8%);Slight complications after operation disappeared during one week. Conclusion Intravitreal injection of Ranibizumab for exudative AMD was well tolerated,with an improvement in VA,FFA or ICGA,and OCT.