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1.
谱域光学相干断层扫描技术( spectral-domain optical coherence tomography,SD-OCT)的革新可以协助我们更好地观察新生血管性老年性黄斑变性( neovascular age-related macular degeneration,NVAMD)的病程进展,并且监测其治疗效果。抗血管内皮生长因子( anti-vascular endothelial growth factor,抗VEGF)药物治疗这种新型方法,已被证实可以有效治疗NVAMD,然而治疗后的长期随访和再治疗成为维持现有视力的关键问题。在抗VEGF治疗过程中, SD-OCT成像有助于早期识别脉络膜新生血管的复发。本文将进一步阐述在NVAMD患者接受玻璃体腔注射抗VEGF治疗后, SD-OCT在随访中的作用。  相似文献   

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目的:利用光相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,nARMD)患者的脉络膜新生血管(choroidal neovascularization,CNV)及接受抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗前后的变化。

方法:本研究为病例系列分析研究。纳入2017-05/12就诊于我院眼科的nARMD患者29例37眼。所有患者玻璃体腔注射抗VEGF治疗前和治疗后1d,1wk,1mo及每月随访时均行OCTA检查,共随访3~6mo,观察抗VEGF治疗前后CNV病灶形态和大小、中心凹旁浅层视网膜血管密度和血流灌注的变化。

结果:nARMD患者CNV病灶的组织结构中不成熟的结构、小分支血管和毛细血管对抗VEGF的治疗应答反应较好; 术前基线病灶面积为1.27±1.88mm2,术后第1d病灶面积为1.13±1.79mm2,CNV病灶在抗VEGF治疗后1d即可缩小,最终病灶大小稳定在1mo时的病灶面积水平,与治疗前比较差异有统计学意义(P=0.001); 抗VEGF治疗后3mo,中心凹旁浅层视网膜血管密度和血流灌注明显降低,差异有统计学意义(P=0.003、0.015)。

结论:OCTA能够无创、清晰地显示nARMD患者CNV病灶的细微结构变化和定量分析CNV病灶面积的变化。OCTA还能够对视网膜血管进行分层显示,定量分析视网膜微循环的变化,在nARMD患者的病情监测和指导治疗方面有重要的临床应用价值。  相似文献   


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Objectives: To determine the repeatability of Stratus optical coherence tomography fast macular thickness map analysis in patients with active neovascular age‐related macular degeneration (nAMD). Methods: Consecutive pairs of scans from 112 eyes of 112 consecutive patients with active nAMD were analyzed. The Bland–Altman coefficient of repeatability (CR) was calculated for each retinal thickness or volume measure. Results: The CR for the central 1 mm macular subfield was 59 μm (18% of retinal thickness) and did not exceed 69 μm in any subfield. There was much poorer repeatability for the center‐point thickness (CPT) measure (CR of 78 μm; 24%). However, in the subgroup of 38 patients with no Stratus software low analysis confidence message on either analysis map, the revised CR (42 μm) for the CPT measure and the A1 subfield (40 μm) were similar. Conclusion: Optical coherence tomography‐derived retinal thickness measurements are subject to measurement variability in patients with active nAMD. The results suggest a change criterion of more than 59 μm in central 1 mm (A1) subfield macular thickness is necessary to distinguish true clinical change from measurement variability in these patients.  相似文献   

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Purpose: To assess the interobserver variability (IOV) in indicating retreatment for neovascular Age‐related macular degeneration 4 weeks after three Ranibizumab loading doses using spectral domain OCT (SD‐OCT) as the primary objective diagnostic tool. Material and methods: Four observers decided for or against 4th Ranibizumab injection in 108 patients by six different rating rounds (RR) based on the SD‐OCT findings after the loading doses. Postoperative OCT images were supplemented consecutively with information from a chart review as the ‘patients subjective estimation of vision (SE)’, the course of best‐corrected visual acuity (BCVA) and the preoperative OCT as well as all information collectively. Agreement rates (AR) and Kappa statistics were calculated. Results: Based on post‐treatment OCT findings only (RR1), mean reinjection rate of all observers was 37.5%. Adding supplementary information, mean reinjection rate decreased to 20% when all information was available reflecting the ‘real’ situation (RR 6). Interobserver agreement rates varied from 66.7% to 90.7% depending on rating rounds and interobserver pairs. Mean AR and Kappa values (KV) were as following: AR 81.6%, KV 0.61 (RR1: ‘only post‐OP OCT’); AR 76.7%, KV 0.33 (RR2: post‐OP OCT + SE); AR 80.3%, KV 0.45 (RR3: post‐OP OCT + BCVA); AR 80.7%, KV 0.46 (RR4: pre‐ and post‐OP OCT); AR 82.2%, KV 0.49 (RR5: post‐OP OCT + SE + BCVA); and finally AR 83.6%, KV 0.47 (RR6: pre‐ and post‐OP OCT + SE + BCVA). The overall mean agreement rate was 80.9% with a Kappa of 0.47. Conclusion: IOV for indicating retreatment after three Ranibizumab loading doses reveals only moderate agreement in Kappa statistics, which seems to be too low considering the high costs for retreatments. More concise guidelines based on the post‐treatment OCT scans as the presumably most sensitive and noninvasive objective tool to follow choroidal neovascularization activity by judging the course of sub‐ and intraretinal fluid are necessary.  相似文献   

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Purpose:

To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided bevacizumab treatment for neovascular age- related macular degeneration (AMD).

Settings and Design:

Single center observational study.

Materials and Methods:

We confirmed wet AMD in 47 eyes of 45 patients by fluorescein angiography and SD-OCT. After bevacizumab injection, we examined the patients at 4-week intervals. During each follow-up control, we performed SD-OCT and a complete ophthalmic examination. Criteria for reinjection were visual acuity loss of more than five ETDRS letters, and/or increase of central retinal thickness, sub-retinal fluid, intra-retinal fluid, pigment epithelium detachment. If reinjection criteria were not met, we advised the patient to return in 4 weeks’ time for the next scheduled follow-up. We used 3-dimensional SD-OCT to measure photoreceptor defects and sub-retinal fibrosis. The main efficacy endpoints were the SD-OCT measurements of the size of photoreceptor defects, the size of external membrane defects and the central retinal thickness.

Results:

Over the 12 months study period, the percentage of scans in 3-D imaging mode showing visible defects of the junction between inner and outer segments of photoreceptors increased from 38.96 to 53.8%. The percentage of scans in 3-D imaging mode with visible sub-retinal fibrosis increased from 33 to 52% and mean central retinal thickness decreased from 333 μm (96-900 μm) to 272 μm (P = 0.011).

Conclusion:

In long-term anti- Vascular endothelial growth factor (VEGF) treatment for neovascular AMD, photoreceptor defects and fibrosis progress despite a decrease in central retinal thickness and improvements in visual acuity. We would encourage further discussion as to whether this is the natural course of the disease or a result of the treatment.  相似文献   

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Purpose: To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age‐related macular degeneration (ARMD). Methods: A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre‐treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. Results: Forty‐four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time‐points during follow‐up. No significant ocular or systemic adverse effects were observed. Conclusion: Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short‐term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group.  相似文献   

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Purpose: To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age‐related macular degeneration (AMD) using an as required dosing regimen. Methods: A retrospective study of 210 patients (231 eyes) with choroidal neovascularization resulting from neovasacular AMD. Patients were treated with 1.25 mg intravitreal bevacizumab at a vitreoretinal practice in Adelaide, South Australia. Patients were followed up at 2–4 weeks and then at 1‐month intervals; repeat injections were offered in the event of recurrence. Recurrence was defined as either a decrease of best‐corrected visual acuity or an increase in macular oedema, subretinal fluid or intraretinal fluid on optical coherence tomography, after complete or partial resolution in previous follow‐up visits. Patient data were collected for 12 months of follow up or until the patient's treatment was changed to ranibizumab. Results: Significant improvement in visual acuity and central retinal thickness was demonstrated at 1 month with an improvement of vision from logMAR equivalent 0.76 to 0.68 (P < 0.001) and a decrease of central retinal thickness from 306 µm to 244 µm (P < 0.001). This overall improvement was continued throughout the 12‐month follow‐up period; however, follow up was poor with 12‐month data available for only a small number of patients (7.8%). Ocular and systemic side‐effects were rare at 3.5% and 0.4%, respectively. Conclusion: Eyes with neovascular AMD treated with intravitreal bevacizumab for up to 12 months had significant functional and anatomical improvement. Further studies need to confirm the long‐term safety and efficacy of this treatment.  相似文献   

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Purpose: The purpose of this study was to understand clinical significance of near‐infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near‐infrared autofluorescence (NIA) in dry age‐related macular degeneration (AMD), by correlation with fluorescein angiography (FA) and cross‐sectional spectral domain optical coherence tomography (SD OCT). Methods: We evaluated 110 eyes (62 patients, mean age: 64 ± 8 years) diagnosed with dry AMD between January 2010 and December 2010, which underwent NIR (λ = 830 nm), FAF and FA (excitation λ = 488 nm; emission λ > 500 nm), NIA (excitation λ = 787 nm; emission λ > 800 nm), and simultaneous SD OCT scanning using a combined confocal scanning laser ophthalmoscope/SD OCT device (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany). Results: Drusen showed variable increased/decreased NIR, FAF, NIA and FA, which corresponded to variable increased/decreased thickness of the retinal pigment epithelium (RPE) and possible presence of subretinal deposits on SD OCT. Geographic atrophy (GA) was present in 43/110 eyes (39.0%) and showed increased NIR and fluorescence (FA), absent FAF and NIA, and loss of RPE on SD OCT. The hyperautofluorescence of the GA margin was never larger in FAF than that in NIA, while in 16.2% of cases, it was larger in NIA than that in FAF and corresponded to mild choroidal hyperreflectivity on SD OCT. Conclusions: Simultaneous recording of SD OCT scans provided ultrastructural data for the evaluation of NIR, FAF, NIA and FA in dry AMD. Near‐infrared autofluorescence might detect earlier than FAF areas of RPE cell loss at the GA margin.  相似文献   

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Purpose: Modern therapy of neovascular age‐related macular degeneration consists in intravitreal injections of inhibitors of the vascular endothelial growth factor. An increasing number of these injections is required not only in monthly but also in as‐needed treatment regimen. In this study, it should be examined whether an additional administered photodynamic therapy (PDT) can considerably reduce the number of injection. Methods: In this prospective, randomized study carried out in three large hospitals of Vienna eyes with neovascular age‐related macula degeneration were included. Patients were randomized to either Ranibizumab monotherapy or combined standard fluence PDT and Ranibizumab therapy. All patients received a loading dose of three intravitreal Ranibizumab injections and were thereafter treated in an as‐needed regimen based on distance acuity and retinal thickness values. In the combined treatment group, PDT was administered 1 day after the first Ranibizumab injection. Results: Fifty‐one patients were randomized, 44 were finally included (four screening failures and three withdrawals). Twenty‐four patients were assigned to the monotherapy and 20 patients to the combined treatment group. Fewer injections were required in the combined treatment group (4.7 versus 6.3). Overall the patients lost 0.5 letters; in the combined treatment group, the patients lost mean 7.1 letters; in the monotherapy group, they gained mean 5.1 letters. Retinal thickness decreased significantly in both groups. Conclusion: A significant reduction of the number of required intravitreal injections could be achieved by the additional PDT treatment, but was accompanied by a worse functional outcome in this group.  相似文献   

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Purpose: Choroidal neovascularization (CNV) accounts for 85–90% of severe visual impairment in age‐related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is a major factor mediating angiogenesis, and VEGF inhibitors have become a new treatment modality. In this prospective study, we used bevacizumab (Avastin®), a recombinant monoclonal antibody to VEGF, to treat neovascular AMD. Methods: The case material comprised 36 subjects (26 females, 10 males) aged 65–88 years with subfoveal neovascular AMD with all subtypes of CNV. There were two categories of patients: category I, long‐standing CNV (12 months or more), preoperative visual acuity (VA) 0.16 (mean); category II, CNV (duration <12 months), preoperative VA 0.25 (mean). Evaluation protocol included the Early Treatment Diabetic Retinopathy Study (ETDRS) VA, clinical ophthalmological examination, fluorescein angiography and optical coherence tomography (OCT). Intravitreal injections of bevacizumab (Avastin®) (IVB), 1.25 mg (0.05 ml), were given under an operating microscope and aseptic conditions in a theatre for surgery with intervals of 4 or 6 weeks during the first 3 months and subsequently according to clinical assessment. The follow‐up was 6 months in all cases. Results: At 6 months, mean VA had improved by 4.6 ETDRS letters in the entire case material (P = 0.001), by 3.9 letters in category I (duration 12 months or more) and by 6.0 letters in category II (duration <12 months). A total of 148 IVB (mean 4.1 injections/eye) were delivered during 6 months, the first 3 months comprising 3.1 IVB (mean) and the last 3 months 1.0 IVB (mean). No eyes suffered visual decline of 15 ETDRS letters. Fluorescein angiograms displayed stabilization or regression of CNV activity; OCT showed resorption of intraretinal oedema and subretinal fluid. No severe complications occurred but recurrence was common, and repeated IVBs were necessary in most cases during the 6‐month period. Conclusion: When addressing the issue of frequency of IBV, we observed that 6‐week intervals were sufficient because VA and CNV lesions generally stabilized at 4 weeks. The gain in VA was promising in eyes with <12 months CNV duration. Even in eyes with a longer CNV duration, a slight visual improvement was observed when retinal oedema resorbed, although subretinal fibrosis and general cellular damage certainly limited recovery.  相似文献   

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Purpose: To report the effects of intravitreal bevacizumab (Avastin®) in treatment‐naive patients with exudative age‐related macular degeneration (ARMD) assessed by visual acuity (VA), optical coherence tomography (OCT) and contrast sensitivity. Methods: A prospective, uncontrolled, pilot study of 26 eyes of 26 patients, all previously treatment‐naive to photodynamic therapy, argon laser or anti‐vascular endothelial growth factor (VEGF), were treated with one or more intravitreal injections of 1.25 mg bevacizumab. Of the 26 patients, 15 (57.7%) had occult choroidal neovascularization (CNV), 6 (23.1%) had predominantly classic CNV and 5 (19.2%) had minimally classic CNV. Ophthalmic outcome measures included changes in standardized Early Treatment Diabetic Research Study (ETDRS) VA, contrast sensitivity and OCT. The patients were examined at baseline and 1 week, 6 weeks, 3 months and 6 months after the first injection. Re‐treatment was given on an ‘as needed’ basis. Results: Twenty‐four eyes of 24 patients completed 6 months of follow‐up. Two patients chose to discontinue the study. Mean ETDRS VA score improved from 55 letters at baseline to 60 letters at 1 week (P < 0.01) and to 61 letters at 6 weeks (P < 0.01). No significant improvement in VA from baseline was found after 3 and 6 months. Patients with pigment epithelial detachment (PED) had a significantly worse outcome in VA at 6 months. Contrast sensitivity improved from baseline to 3 or 6 months, but this improvement was not statistically significant. Mean macular thickness decreased significantly from baseline to all follow‐up examinations (P < 0.01). Conclusion: Mean ETDRS VA improved significantly after 1 and 6 weeks; thereafter, it remained stable throughout the study period. Macular thickness improved significantly at all time points. The results indicate that 1.25 mg intravitreal bevacizumab is associated with functional as well as morphological improvement among treatment‐naive ARMD patients.  相似文献   

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光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)是一种快捷的、无创的新兴成像技术,可以定性、定量分析视网膜血流灌注,在临床的应用越来越广泛。脉络膜新生血管(choroidal neovascularization,CNV)是湿性年龄相关性黄斑变性(neovascular age-related macular degeneration,nARMD)导致老年人视力丧失的主要原因,因此在nARMD中对CNV的检测十分重要。本文通过OCTA对CNV的诊断、形态、面积及血流灌注的分析,综述了其在nARMD诊疗中的研究进展。  相似文献   

16.
Purpose: To assess the hemodynamic response of retinal arterioles and venules following a single intravitreal injection of ranibizumab in neovascular age‐related macular degeneration (NV‐AMD) patients and to assess the influence of the number of prior injections on this response. Methods: Fifteen NV‐AMD patients were prospectively recruited and grouped according to the dosage of ranibizumab previously received. Group 1 NV‐AMD patients (n = 7) had previously received 1.50 mg or less, and group 2 patients (n = 8) had received more than 1.50 mg in the study eye. A group of 12 non‐NV AMD patients were also recruited for control comparison. Vessel diameter, centreline blood velocity and blood flow were assessed with the Canon Laser Blood Flowmeter immediately prior to an injection and at a mean follow‐up of 37.7 and 36.7 days for group 1 and group 2 patients, respectively. Results: The NV‐AMD patients as a whole and the group 1 cohort had a significantly greater arteriolar diameter at baseline than the non‐NV AMD patients. There was a significant reduction in arteriolar diameter, velocity and blood flow in group 1 but not in group 2 NV‐AMD patients at follow‐up. There was only an insignificant decrease in measured parameters of the retinal venules. At follow‐up, there was no difference in the diameter, velocity or flow between AMD patients. Conclusion: Intravitreal ranibizumab treatment for NV‐AMD induces a reduction in arteriolar diameter, velocity, and blood flow in patients who have received <1.50 mg of ranibizumab.  相似文献   

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Purpose: Conventional time‐domain optical coherence tomography (OCT) has become an important tool for following dry or exudative age‐related macular degeneration (AMD). Fourier‐domain three‐dimensional (3D) OCT was recently introduced. This study tested the reproducibility of 3D‐OCT retinal thickness measurements in patients with dry and exudative AMD. Methods: Ten eyes with dry AMD and 12 eyes with exudative AMD were included in the study. Sets of three OCT 6 × 6‐mm raster scans were taken by one operator. Mean retinal thickness was calculated for 36 areas. Coefficients of variation (CoV) were calculated for each patient and area. For analysis, two separate areas (central and peripheral) were defined. Generalized estimating equations (GEEs) were applied to all 36 subfields in order to analyse possible differences in CoV and mean retinal thickness between dry and exudative AMD. Results: Mean retinal thickness values were significantly larger in the central area in exudative AMD (p < 0.001). Mean CoV for exudative AMD was 3.7% (standard deviation [SD] 1.4%). Mean CoV for dry AMD was 1.8 (SD 0.6%). The reproducibility of retinal thickness measurements was significantly less in exudative AMD (p = 0.009). Conclusions: Reproducibility of 3D‐OCT retinal thickness measurements was good in both groups. However, reproducibility was significantly better in dry AMD than in exudative AMD.  相似文献   

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Purpose: This open‐label, prospective, small‐scale study investigated the benefits of same‐day verteporfin and intravitreal ranibizumab in patients with predominantly classic, minimally classic or occult subfoveal choroidal neovascularization (CNV) secondary to age‐related macular degeneration. Methods: Patients received verteporfin at baseline and at month 3, if leakage persisted. Ranibizumab (0.5 mg) was given at baseline and months 1, 2 and 3, and thereafter at monthly intervals if required. Same‐day ranibizumab was given ≥ 1 hr after verteporfin. Results: Fifteen patients [11 male, four female; mean age 75.5 years (range 54–94 years)] were treated. At day 360, mean visual acuity (VA) had improved by 10.9 letters. An increase of ≥ 15 and ≥ 30 letters (i.e. ≥ 3 and ≥ 6 lines) was observed in seven (47%) patients and one patient (7%), respectively. Mean central retinal thickness (CRT) decreased by 85 μm. At days 7, 14 and 30, CNV perfusion was absent in 14/15 patients. Mean lesion area had reduced from baseline by 23.1% at day 120, 25.5% at day 180 and 23.6% at day 360. There were no visual safety concerns and intraocular pressures remained normal. Only two serious adverse events were recorded over the 12‐month period, and neither was considered to be related to treatment. Conclusion: Same‐day verteporfin plus ranibizumab improved VA, reduced CRT, prevented CNV perfusion and reduced lesion area safely over 12 months. Further investigation is warranted to confirm whether this combination improves long‐term vision and reduces the need for retreatment.  相似文献   

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