抗血管内皮生长因子单克隆抗体Ranibizumab联合光动力疗法治疗渗出型年龄相关性黄斑变性的临床观察

目的 观察抗血管内皮生长冈子单克隆抗体Ranibizumab玻璃体腔注射联合光动力疗法（PDT）治疗渗出型年龄相关性黄斑变性（AMD）的临床疗效和安全性.方法 回顾性系列病例研究.确诊为渗出型AMD并首次接受Ranibizumab玻璃体腔注射联合PDT治疗的患者32例（41眼）,均进行了糖尿病早期治疗研究（ETDRS）视力表、彩色眼底照像、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）、光学相干断层扫描（OCT）等检查,确诊为渗出型AMD后采用PDT（光辐射率600 mW/cm2,光能量50 J/cm2,光照时间83 s）治疗,48-72 h后玻璃体腔注射Ranibizumab 0.5 mg（0.05 ml）,随后根据每个月检查情况决定是否再次治疗,重复治疗时单独注射Ranibizumab 0.5 mg,或联合PDT,或单独PDT.采用配对t检验比较治疗前后视力（ETDRS字母数）、视网膜厚度,对脉络膜新生血管（CNV）病灶渗漏情况进行计数,求百分比.结果 随诊12-39个月.在治疗后第12个月检查时,41眼ETDRS视力表字母数较治疗前平均提高9.1个字母（t=-4.14,P＜0.01）,重复Ranibizumab注射（2.0±1.1）次/眼,重复PDT治疗（0.2±0.8）次/眼.末次检查时,41眼ETDRS视力表字母数较治疗前平均提高8.9个字母（t=-3.74,P＜0.01）,重复Ranibizumab注射（2.7±1.2）次/眼,重复PDT治疗（0.3±0.7）次/眼.9眼（22%）CNV渗漏完全停止,27眼（66%）渗漏范围减少,3眼（7%）无明显变化或范围扩大,2眼（5%）有新病灶发生.OCT检查显示视网膜厚度较治疗前平均下降119.11μm（t=4.419,P＜0.01）.并发症与单独Ranibizumab或PDT治疗相比无增加.结论 Ranibizumab玻璃体腔注射联合PDT治疗渗出型AMD可使视力提高,视网膜水肿明显减轻,CNV病灶渗漏停止或减少,具有良好的疗效和较高的安全性.

Clinical observations of intravitreal injection of Ranibizumab combined with photodynamic therapy for exudative age-related macular degeneration

Objective To observe the efficacy and safety of an intravitreal injection of Ranibizumab combined with photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD). Methods Retrospective case series study. To analyze the clinical data of 32 patients (41eyes) with exudative AMD who received an intravitreal injection of Ranibizumab combined with PDT for the initial treatment. All patients were assessed by ETDRS visual acuity chart, color fundus photography, fluorescein angiography (FFA) or indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Patients underwent PDT (600 mW/cm2, 50 J/cm2, 83 s), then Ranibizumab 0.5 mg (0.05 ml) was injected intravitreally 48-72 hours later. Treatments were repeated as follows: a single intravitreal injection of Ranibizumab 0.5 mg (0.05 ml), intravitreal injection of Ranibizumab combined with PDT, or just PDT if the monthly follow-up indicated. Performance on the ETDRS chart and retinal thickness before and after the treatment were analyzed with paired t test, leakage of choroidal neovascularization (CNV) complications were counted, and described by percentages. Results The follow-up period lasted 12-39 months. At the 12th month of the follow-up period, performance on the ETDRS chart had improved by 9.1 letters (t=-4.14, P＜0.01).Intravitreal injections of Ranibizumab were repeated (2.0±1.1)times/eye on average, and PDT was repeated (0.2±0.8)times/eye on average. At the end of the follow-up period, performance on the ETDRS chart had improved by 8.9 letters (t=-3.74, P＜0.01 ). Intravitreal injections of Ranibizumab were repeated (2.7±1.2)times/eye on average, and PDT was repeated (0.3±0.7)times/eye on average.CNV showed complete closure in 9 eyes (22%), partial closure in 27 eyes (66%), no change or expansion in 3 eyes (7%), and new CNV in 2 eyes (5%). The mean foveal thickness in the OCT images decreased 119.11 μm compared to that before treatment (t=4.419, P＜0.01). There was no increase in adverse reactions compared to a single intravitreal injection of Ranibizumab or PDT.Conclusion Intravitreal injection of Ranibizumab combined with photodynamic therapy for exudative AMD is well tolerated, with improvements in visual acuity, FFA or ICGA and OCT performance,and has good efficacy and safety.