卵磷脂络和碘胶囊辅助治疗视网膜静脉阻塞的临床疗效研究

目的 探究卵磷脂络合碘胶囊联合雷珠单抗对视网膜静脉阻塞继发黄斑水肿(RVO-ME)的临床疗效。方法 选取2020年1月至2021年2月就诊的40例40眼RVO-ME患者为研究对象,随机分为两组,雷珠单抗组和卵磷脂联合组,雷珠单抗组19例,卵磷脂联合组21例,雷珠单抗组每4周给予玻璃体腔内注射雷珠单抗治疗,卵磷脂联合组是在雷珠单抗组治疗的基础上加用卵磷脂络合碘胶囊治疗,治疗12周,治疗期间每4周随访一次,观察治疗前后眼压、最佳矫正视力(BCVA)、眼底出血面积、黄斑中心区厚度(CMT)、中心凹无血管区(FAZ)、脉络膜血流面积(CFA)、浅层视网膜毛细血管层(SCP)和深层视网膜毛细血管层(DCP)的血管密度变化,并观察有无不良事件和不良反应的发生。结果 两组患者各治疗时间点BCVA(LogMAR)、CMT均较治疗前改善,组间比较均无统计学差异。FAZ、SCP两组患者治疗前后无统计学差异,且组间比较无统计学差异。两组患者各治疗时间点眼底出血面积均较治疗前减少,卵磷脂联合组各治疗时间点的眼底出血吸收情况均优于雷珠单抗组,差异具有统计学意义。两组患者治疗前后CFA有增加趋势,差异具有统计学意...     

地塞米松玻璃体内植入与雷珠单抗治疗视网膜静脉阻塞的疗效比较

目的:比较地塞米松玻璃体内植入与玻璃体注射雷珠单抗治疗视网膜静脉阻塞(RVO)的疗效。方法:回顾性研究。选取本院40例ROV患者,根据治疗方式不同分为2组,A组采用地塞米松玻璃体内植入进行治疗,B组采用玻璃体腔注射雷珠单抗,比较两组患者治疗前后眼压、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、浅层血管复合体(SVC)层、深层血管复合体(DVC)层、脉络膜层与脉络膜毛细血管层黄斑区血流密度(MVD)、黄斑中心凹无血管区(FAZ)面积,记录复发及不良反应情况。结果:两组患者治疗12mo BCVA、CMT均较治疗前得到明显改善(P<0.05),但两组间比较无显著差异(P>0.05);治疗后,两组间SVC层、脉络膜层、脉络膜毛细血管层MVD比较均无显著差异(P>0.05),A组DVC层MVD显著大于B组(P<0.05);两组患者治疗前后浅层与深层FAZ面积比较均无显著差异(P>0.05);两组患者治疗后结膜下出血、异物感发生率比较均无显著差异(P>0.05),A组高眼压发生率明显高于B组(P<0.05);两组患者黄斑水肿(ME)复发率比较无显著...     

Intravitreal Ranibizumab for Treatment of Choroidal Neovascularization Secondary to Angioid Streaks in Pseudoxanthoma Elasticum: Five-year Follow-up

Purpose: To report on the five-year follow-up of ranibizumab therapy for choroidal neovascularization (CNV) secondary to angioid streaks (AS) in pseudoxanthoma elasticum (PXE).

Methods: A 51-year-old patient with PXE presenting with macular CNV secondary to AS was treated with a series of intravitreal ranibizumab (0.5 mg) injections and followed for five years with fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA).

Results: Fluorescein leakage resolved and OCT evidence of subretinal and intraretinal fluid disappeared one year after presentation following an initial 12 injections. There was mild recurrent neovascular activity on two occasions resulting in two injections in the four years subsequent to resolution. Though peripapillary scar formation occurred, the fovea was preserved with 20/20 visual acuity in the affected eye at five years.

Conclusions: This case provides further evidence for the long-term effectiveness of ranibizumab in the treatment of CNV secondary to AS in PXE. Though multiple initial injections were required to control the disease, once stabilization of the CNV was achieved, recurrent neovascular activity was minimal.     

Verteporfin photodynamic therapy and anti-angiogenic drugs: potential for combination therapy in exudative age-related macular degeneration

ABSTRACT

Objective: To discuss the rationale for combining anti-angiogenic treatment with verteporfin (Visudyne^*) photodynamic therapy in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) and evaluate available evidence for the therapeutic benefits of such approaches.

Scope: The Medline and EMBASE databases were searched in October 2006 to retrieve relevant articles. Additional articles were obtained from the reference lists of retrieved articles, as well as from recent scientific meetings and company websites.

Findings: Treatments for CNV due to AMD can be directed at either the vascular component of CNV (the new vessels that proliferate and leak blood and fluid) or the angiogenic component that leads to the development of the condition. Verteporfin targets the vascular component, whereas anti-angiogenic agents (such as pegaptanib and ranibizumab) target key mediators of the angiogenic cascade. The different mechanisms of action of these approaches offer the potential for additive or synergistic effects with combination therapy. In addition, anti-angiogenic agents might counteract upregulation of angiogenic factors (including VEGF) that occur after verteporfin photodynamic therapy. Results from preclinical and clinical studies of the combination of ranibizumab or pegaptanib with verteporfin warrant continued investigation.

Conclusions: The use of anti-angiogenic agents in combination with verteporfin may have the potential to improve visual outcomes and reduce the number of treatments in eyes with CNV due to AMD, and requires further evaluation in randomized, controlled clinical trials.     

不同方法治疗视网膜中央静脉阻塞黄斑水肿的对比观察

目的：鉴于视网膜中央静脉阻塞central retinal vein occlusion（CRVO）;所致持续性黄斑水肿persistent macular edema（ME）;治疗有很多争议,探讨更有效的治疗办法。方法：玻璃体腔注射曲安奈德（TA）3l例、注射抗血管内皮生长因子单克隆抗体（Ranibizumab）30例,和两组中注药加激光21例,通过测量视力、眼压,中央视网膜厚度等方面来探讨玻璃体腔注射Ranibizumab、TA和注药＋激光光凝治疗效果,并应用统计学方法进行分析对比。结果：注射Ranibizumab组和TA组：最佳矫正视力在注药前后对比,两组均有显著统计学差异。中央视网膜厚度在注药前后对比,两组亦均有统计学差异。结论：玻璃体腔注射TA与Ranibizumab在治疗CRVO继发黄斑水肿时,均在短期内能明显降低水肿的视网膜和改善视力,Ranibizumab反复注射的次数要比TA多一些;TA比Ranibizumab副作用多,安全性差。激光和注药相比并不能够改善视力,但对减轻水肿和防止新生血管性青光眼有作用,故在必须时要慎重选择。     

玻璃体腔单次注射雷珠单抗治疗糖尿病黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的评价玻璃体腔单次注射抗血管内皮细胞生长因子药物雷珠单抗治疗糖尿病黄斑水肿DME和视网膜静脉阻塞（RVO）性黄斑水肿的短期疗效。方法在安徽医科大学第一附属医院规律随访符合纳入和排除标准的DME和RVO黄斑水肿者23只眼。患眼给予玻璃体腔注射0.05 ml雷珠单抗注射液,治疗后2 d复查最佳矫正视力,治疗后4周进行复查最佳矫正视力、黄斑中心凹厚度、黄斑区平均厚度和Amsler表。结果治疗后2 d与治疗前相比,视力提高（t=4.632,P〈0.001）。治疗后4周与治疗前相比,黄斑中心凹厚度降低（t=10.165,P〈0.001）,黄斑区平均厚度降低（t=3.368,P=0.003）,视力提高（t=7.281,P〈0.001）。Amsler表阳性率下降（χ2=8.013,P=0.005）。差异均具有统计学意义。治疗后4周与治疗后2 d相比,视力提高,差别有统计学意义（t=5.271,P〈0.001）。黄斑中心凹厚度与Amsler表阳性率的相关性分析：无统计学意义（相关系数0.128,P=0.398）。结论玻璃体腔单次注射雷珠单抗对DME和RVO黄斑水肿在4周内有效。