玻璃体切除联合Conbercept玻璃体腔注射治疗PCV并发玻璃体积血

目的:探讨息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)并发玻璃体积血的患者行玻璃体切除术联合康柏西普(Conbercept)玻璃体腔注射的临床疗效.方法:回顾性筛选2014-02/2015-07我院收治的11例11眼首诊为玻璃体积血的患者,其中男7例,女4例;年龄65 ～ 79(平均69.5 ±9.0)岁,术前视力:光感者1眼,手动者7眼,眼前/指数者3眼,11眼均给予玻璃体切除术及C3F8填充并联合超声乳化白内障摘除及人工晶状体(IOL)植入术.术前有3例患者行FFA及ICGA造影检查确诊为PCV,其余8例患者于玻璃体切除术后1mo时行FFA及ICGA造影检查确诊为PCV.于玻璃体切除术后1mo对11例患者明确诊断后,即行首次康柏西普玻璃体腔注射,注射剂量为0.5 mmg(0.05 mL),连续3次,间隔1 mo,此后根据随访情况,当病情加重或复发时追加一次注射治疗.所有患者于首次康柏西普玻璃体腔注射后随访12 mo.本研究观察玻璃体切除术前、术后1 mo,和首次康柏西普注射后l、2、3、4、5、6、9、12mo的眼底、B超、最佳矫正视力(best corrected visual acuity,BCVA)、光学相干断层扫描(optical coherence tomography,OCT)等情况,对此四项指标进行临床疗效观察.结果:随访至康柏西普注射后12mo时,眼底检查显示11眼患者视网膜深层及浅层出血完全吸收,其中5眼患者仍可见视网膜下橘红色病灶;B超显示11眼患者视网膜下积血完全吸收;11眼患者的BCVA均较术前明显提高,其中有3眼患者诉存在不同程度的视物变形等情况;OCT显示黄斑中心视网膜厚度明显下降,其中有6眼患者仍存在浆液性视网膜色素上皮脱离.结论:玻璃体切除术为PCV并发玻璃体积血患者的明确诊断及后续治疗创造了条件;玻璃体切除术后联合康柏西普玻璃体腔注射治疗,能快速促进视网膜出血及渗出的吸收,减轻视网膜的水肿,促使息肉状病灶的消退,有效地提高患者的预后视力.

Effect of vitrectomy combined with intravitreal Conbercept injection for polypoidal choroidal vasculopathy associated with vitreous hemorrhage

AIM: To evaluate the effectiveness of vitrectomy combined with intravitreal Conbercept injection for 11 polypoidal choroidal vasculopathy(PCV)associated with vitreous hemorrhage patients.

METHODS: We retrospectively analyzed the clinical data of 11 patients(7 males and 4 females, 11 eyes)who were first diagnosed with vitreous hemorrhage between Feb. 2014 and Jul. 2015 in our hospital. These patients aged 65 to 79 years(mean 69.5±9.0y). The best corrected visual acuity(BCVA)was light perception in 1 eye, hand moving in 7 eyes, counting finger in 3 eyes. Vitrectomy combined with cataract extraction were operated in all 11 patients, which all patients were given gas tamponade. Three patients were diagnosed as polypoidal choroidal vasculopathy through fundus fluorescence angiography(FFA)and Indocyanine green angiography(ICGA)before vitrectomy(8 eyes were diagnosed as polypoidal choroidal vasculopathy after vitrectomy 1mo). Eleven patients were treated with an intravitreal Conbercept injection, received intravitreal injection of Conbercept(0.5mg, 0.05 mL)once a month for 3 consecutive months. If disease progressed or recurred during follow- up, the patients were re-injected with Conbercept. All the patients completed 12mo of follow-up after the first intravitreal Conbercept injection. The examination of the ocular fundus, B-ultrasound, best-corrected visual acuity(BCVA)and optical coherence tomography(OCT)were performed before vitrectomy, 1mo after vitrectomy and 1, 2, 3, 4, 5, 6, 9 and 12mo the first intravitreal Conbercept injection in 11 patients.

RESULTS: At 12mo of follow-up, the fundus examination revealed that the retinal deep and superficial hemorrhage of 11 patients were completely absorbed, which the subretinal orange-red lesions were still visible in 5 patients. B-ultrasound revealed that subretinal hemorrhage of 11 patients were also completely absorbed. The best corrected visual acuity of 11 patients were significantly improved, but metamorphopsia were still existence in 3 patients. The optical coherence tomography revealed that macular central retinal thickness were significantly decreased, but serous retinal pigment epithelium detachment were still existence in 6 patients.

CONCLUSION: Vitrectomy is effective for the treatment and definite diagnosis of polypoidal choroidal vasculopathy associated with vitreous hemorrhage patients. Vitrectomy combined with intravitreal Conbercept can facilitate the absorption of hemorrhage and exudates, relieve edema of the retina, promote the regression of the polyps and increase the patients'' visual acuity.