OCTA在玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管中的应用

目的:利用光学相干断层扫描血管造影技术观察病理性近视脉络膜新生血管抗VEGF治疗期间的变化,探讨其在监测抗VEGF治疗过程的意义.方法:本研究纳入临床确诊病理性近视脉络膜新生血管患者30例30眼.对患眼行玻璃体腔注射10 mg/mL雷珠单抗0.05mL,治疗后每月随访病情,随访时间为6mo,每次随访均行最佳矫正视力(BCVA)、眼压、裂隙灯、前置镜眼底检查、OCTA检查.比较治疗前、治疗后1、3、6 mo患者BCVA及黄斑中心视网膜厚度(CMT).结果:所有患者平均玻璃体腔注射1.70±0.65次.治疗前平均最佳矫正视力(LogMAR)为0.96±0.17,治疗后1、3、6mo视力分别提高了0.23±0.09、0.34±0.07、0.38±0.11,差异均有统计学意义(t=5.461、8.191、8.894,P<0.05).治疗前平均CMT为281.07±13.72μm,治疗后1、3、6mo分别下降了19.73±9.02、37.62±15.41、46.15±25.16μm,差异均有统计学意义(t=12.007、13.360、9.531,P<0.05).注射后OCTA显示CNV血管网直径缩小,密度降低.结论:玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管疗效显著、安全性高;OCTA能无创、快速获得视网膜和脉络膜血管图像,为诊断病理性近视脉络膜新生血管和监控其治疗效果提供有力工具.     

联合抗VEGF药物的综合疗法治疗新生血管性青光眼的临床疗效

目的　探讨联合抗血管内皮生长因子（vascular endothelial growth factor,VEGF）药物的综合疗法治疗新生血管性青光眼（neovascular glaucoma,NVG）的临床疗效。方法　选取2015年1月至2017年10月在我院住院治疗的NVG患者60例（60眼）,将所有患者按手术方案不同分为试验组和对照组,每组30例（30眼）,试验组采用抗VEGF综合疗法,即抗VEGF药物玻璃体内注射、全视网膜光凝（panretinal photocoagulation,PRP）及复合小梁切除术联合治疗方案。对照组行传统的睫状体冷凝术。比较两组患者治疗前及治疗后1周、2周、1个月、2个月、3个月的眼压、视力变化及临床疗效,随访时间为3个月。结果　两组患者基线特征比较差异无统计学意义（P＞0.05）。两组患者治疗后眼压变化差异有统计学意义（P＜0.05）;两组患者治疗后视力比较差异有统计学意义（χ²=7.680,P＜0.05）;两组患者临床疗效（试验组86.67%、对照组83.33%）比较差异无统计学意义（P＞0.05）;两组患者眼轴长度变化差异有统计学意义（t=5.835,P＜0.05）。结论　NVG患者接受抗VEGF药物综合疗法能获得正常稳定的眼压,稳定术前视力,减少术后并发症,避免眼球萎缩。     

兰尼单抗和曲安奈德玻璃体内注射后眼压的即时升高

目的:前瞻性评估玻璃体腔内注射兰尼单抗、2和4mg曲安奈德(TA)后眼压(IOP)的即时变化。方法:接受玻璃体腔内注射0.1mL(4mg)曲安奈德(T4组),0.05mL(2mg)TA(T2组)和0.05mL(0.5mg)兰尼单抗(R组)的患者组成研究群体。总体而言,205例229眼接受注射。T4组54眼(23.6%),T2组69眼(30.1%),及R组106眼(46.3%)。如果注射后即时眼压<26mmHg就不行进一步的测量。如果眼压≥26mmHg,就在5,15和30min后重新测量眼压,直到读数<26mmHg。结果:注射后即时眼压,T4组28眼(51.9%),T2组22眼(31.9%)和R组51眼(48.1%)超过25mmHg。到30min时,T4组1眼(1.9%),T2组2眼(2.9%)和R组2眼(1.9%),眼压超过25mmHg。T4组和R组注射后即时眼压显著高于T2组(P<0.01和P<0.01)。各组中无玻璃体回流眼的眼压显著高于有玻璃体回流眼(P<0.01)。结论:玻璃体腔内注射2或4mg曲安奈德和0.5mg的兰尼单抗后眼压可能会立即显著提高。无玻璃体回流是注射后眼压即时上升的最重要的预测因素。     

Pegaptanib治疗湿性年龄相关性黄斑变性的临床研究

年龄相关性黄斑变性(age-relatedmaculardegeneration,AMD)是发达国家老年人的主要致盲眼病,脉络膜新生血管(choroidalneovascularization,CNV)的形成是湿性AMD患者丧失视力的主要原因。CNV的发生机制尚不清楚,已证实血管内皮生长因子(vascularendothelialgrowthfac-tor,VEGF)是诱发CNV的关键因素之一。Pegaptanib作为眼科领域应用的第一种VEGF抑制剂,通过抑制CNV形成和血管渗漏,对湿性AMD已初步显示出较传统疗法更优越的治疗效果。随着对CNV发生机制的深入研究,针对病因进行治疗,将有可能更加有效的防治湿性AMD等CNV相关疾病。     

Quantitative analysis of retinal intermediate and deep capillary plexus in patients with retinal deep vascular complex ischemia

AIM: To evaluate the efficacy and safety of intravitreal corticoid as an adjunctive therapy to anti-VEGF treatment of neovascular age-related macular Degeneration (nvAMD). METHODS: Four databases including PubMed, Embase, Cochrane Library, and the clinicaltrials.gov were comprehensively searched for studies comparing intravitreal corticoid plus anti-VEGF (IVC/IVA) vs anti-VEGF monotherapy (IVA) in patients with nvAMD. GRADE profiler was used to assess the quality of outcomes. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events including the occurrence of severe elevation of intraretinal pressure (IOP) and the progress of cataract were extracted from the eligible studies. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS: There was no statistic difference between mean change in BCVA at 6mo and 12mo (95% CI: -2.28 to 4.24, P=0.55). Mean change of CMT at 6mo and 12mo: no statistically significant difference were found in CMT at this time point (95% CI:-17.98 to 16.42, P=0.93). Occurrence of severe elevation of IOP: the risk in the IVC/IVA group was higher than that in the IVA group (95% CI: 1.92 to 9.48; P=0.0004). Cataract progression events: no statistic difference was found (95% CI: 0.74 to 4.66; P=0.18). CONCLUSION: No visual or anatomical benefits are observed in IVC/IVA group at 6mo. At 12mo, the CMT of the IVC/IVA group is significantly lower than that of the IVA group. Risk of severe elevation of IOP is significantly higher when treated by IVC/IVA.     

湿性年龄相关性黄斑变性患者抗VEGF治疗无效的因素分析和视功能预后

目的　探讨湿性年龄相关性黄斑变性（wAMD）患者玻璃体内注射抗血管内皮生长因子（VEGF）治疗无效的影响因素和视功能预后。方法　回顾性分析97例（97眼）wAMD患者的临床资料,所有患者均进行连续3个月、玻璃体内每个月注射1次抗VEGF治疗。观察并记录患者治疗后最佳矫正视力（BCVA）、黄斑中心凹视网膜厚度（CMT）。根据患者连续3次抗VEGF治疗后1个月的效果分为无效组和有效组。单因素分析筛选wAMD患者抗VEGF治疗无效的危险因素,多因素Logistic回归分析确定治疗无效的独立危险因素;观察治疗无效患者的后续治疗和视功能预后情况。结果　抗VEGF治疗后1个月、2个月、3个月和末次随访时wAMD患者BCVA较治疗前均有明显改善,差异均有统计学意义（均为P<0.05）,CMT较治疗前均有减低,差异均有统计学意义（均为P<0.05）。连续3次抗VEGF治疗后1个月,wAMD患者无效21眼（无效组）,有效76眼（有效组）。多因素 Logistic 回归分析结果显示:年龄（OR=2.132,95%CI=2.314~44.342,P=0.011）、基线BCVA（OR=8.361,95%CI=7.239~32.764,P=0.009）是抗VEGF治疗无效的独立影响因素。无效组12例（57.1%）更换抗VEGF药物治疗,33.3%患者更换抗VEGF药物后视力改善,5例（23.8%）联合PDT治疗后视力与单纯抗VEGF治疗相比,差异无统计学意义（P>0.05）。结论　高龄及基线视力差是抗VEGF治疗无效的独立影响因素,部分治疗无效患者更换治疗药物后可改善视力预后。     

【In Press】 Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report

AIM: To evaluate the efficacy and safety of combined anti-VEGF, oral glucocorticoid, and laser photocoagulation therapy for macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS: This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal vessel oxygenation were examined over 12 mo.? RESULTS: Patients received 1.43±0.81 anti-VEGF injections. Mean baseline and 12-month logMAR BCVA were 0.96±0.51 [20/178] and 0.31±0.88 [20/40], respectively, in eyes with CRVO (P=0.000), and 1.02±0.45 (20/209) and 0.60±0.49 [20/80], respectively, in eyes with BRVO (P=0.000). At 12 mo, CRT had significantly decreased in eyes with CRVO (P=0.000) and BRVO (P=0.000). Venous SO2 had significantly increased in eyes with CRVO (P=0.004) and BRVO (P=0.002). No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. CONCLUSION: Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO-associated ME.     

眼底新生血管中西医治疗进展研究

眼底新生血管因易致严重的视力下降甚者致盲而成为国内外研究的重点,针对新生血管发挥中医药辨证论治、标本兼治的特色,推进其治疗进展,成为中医眼科学者的努力方向。中西医治疗眼底新生血管各有利弊,现有研究中西医联合的方式更利于新生血管的治疗,故现将当前临床广泛认可的中西医治疗进展与中西医结合治疗的趋势做一综述。     

胎盘生长因子在新生血管性眼病中的研究进展

新生血管是许多致盲性眼病的主要原因,例如糖尿病视网膜病变、早产儿视网膜病变、年龄相关性黄斑变性等。血管内皮生长因子( vascular endothelial growth factor, VEGF)在新生血管的形成中起着重要的作用,被认为是作用最强的血管生长因子。胎盘生长因子( placental growth factor, PlGF)是VEGF家族中的一员,可促进新生血管生成,刺激内皮细胞迁移增殖,介导免疫炎症反应,且特异性表达于病理性新生血管,但在正常血管中不表达。因此近年来PlGF逐渐受到人们关注。本文对PlGF在新生血管性眼病中的作用机制进行探讨。