光动力疗法延长照射时间联合玻璃体腔注射雷珠单抗治疗后极部孤立性脉络膜血管瘤疗效观察

目的观察光动力疗法(PDT)延长照射时间联合玻璃体腔注射雷珠单抗治疗后极部孤立性脉络膜血管瘤(CCH)的疗效。方法回顾性临床研究。2012年3月至2018年3月于深圳市眼科医院检查确诊的CCH患者51例51只眼纳入研究。其中,瘤体位于黄斑区36只眼,位于黄斑外(旁中心外或视盘周边)15只眼。所有患者均行BCVA、眼底彩色照相、FFA、眼B型超声、OCT检查。BCVA检查采用国际标准视力表进行,统计时换算为logMAR视力。51只眼中,伴黄斑区浆液性视网膜脱离48只眼。瘤体位于黄斑区、黄斑外的患眼平均logMAR BCVA分别为0.05±0.05、0.32±0.15;肿瘤厚度、直径分别为(4.5±2.2)、(3.8±1.4)mm和(9.7±3.6)、(7.7±1.9)mm。患眼均行PDT治疗,照射时间123 s;48 h后玻璃体腔注射10 mg/ml雷珠单抗0.05 ml(含雷珠单抗0.5 mg)。治疗后1、3、6个月采用治疗前相同设备和方法行相关检查。观察患眼BCVA、视网膜下积液(SRF)、瘤体渗漏情况及大小变化。治疗前后BCVA、瘤体厚度和直径比较行t检验。结果治疗后6个月,所有患眼瘤体缩小,未见瘢痕形成;瘤体内血管较治疗前稀疏,荧光素渗漏减少,其中未见荧光素渗漏8只眼;伴黄斑区浆液性视网膜脱离的48只眼中,视网膜平复43只眼。瘤体位于黄斑区、黄斑外的患眼平均logMAR BCVA分别为0.16±0.15、0.55±0.21。与治疗前平均logMAR BCVA比较,差异均有统计学意义(t=-2.511、-2.676,P=0.036、0.040)。与治疗前比较,不同位置患眼肿瘤厚度(t=3.416、3.055,P=0.011、0.028)、直径(t=4.385、4.171,P=0.002、0.009)均降低,差异均有统计学意义。结论延长PDT照射时间联合玻璃体腔注射雷珠单抗治疗可使CCH瘤体缩小,BCVA提高。

Effect of prolonged photodynamic therapy irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma

Objective To observe the clinical effect of prolonged photodynamic therapy(PDT)irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma(CCH).Methods A retrospective clinical study.From March 2012 to March 2018,51 eyes of 51 patients diagnosed in Shenzhen Eye Hospital were included in the study.Among the patients,the tumor of 36 eyes were located in macular area,of 15 eyes were located outside macular area(near center or around optic disc).All patients underwent BCVA,color fundus photography,FFA,ocular B-scan ultrasonography and OCT examinations.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.OCT showed 48 eyes with macular serous retinal detachment,of 36 eyes with tumor located in macular area,the logMAR BCVA was 0.05±0.05,the tumor thickness was 4.5±2.2 mm,the diameter of tumor was 9.7±3.6 mm.Of 15 eyes with tumor located outside macular area,the logMAR BCVA was 0.32±0.15,the tumor thickness was 3.8±1.4 mm,the diameter of tumor was 7.7±1.9 mm.PDT was performed for all eyes with the irradiation time of 123 s.After 48 h,all patients received intravitreal injections of 0.5 mg ranibizumab(0.05 ml).At 1,3 and 6 months after treatment,the same equipment and methods before treatment were used for related examination.BCVA,subretinal effusion(SRF),tumor leakage and size changes were observed.BCVA,tumor thickness and diameter before and after treatment were compared by t test.Results At 6 months after treatment,the tumor was becoming smaller without scar formation.FFA showed that the blood vessels in the tumor were sparse compared with those before treatment,and the fluorescence leakage domain was reduced.OCT showed 43 eyes of macular serous detachment were treated after the combined treatment.The logMAR BCVA were 0.16±0.15 and 0.55±0.21 of the eyes with tumor located in or outside macular area,respectively.The difference of logMAR BCVA between before and after treatment was significant(t=-2.511,-2.676;P=0.036,0.040).Both the tumor thickness(t=3.416,3.055;P=0.011,0.028)and diameter(t=4.385,4.171;P=0.002,0.009)of CCH patients were significantly reduced compared with that before treatment.Conclusion The tumor of CCH can be reduced by prolonged PDT irradiation time combined with intravitreal injection of ranibizumab.