光动力疗法与光动力疗法联合玻璃体腔注射贝伐珠单抗治疗中心性渗出性脉络膜视网膜病变的比较研究

目的比较光动力疗法(photodynamic therapy,PDT)与PDT联合玻璃体腔注射贝伐珠单抗(bevacizumab)治疗中心性渗出性脉络膜视网膜病变(CEC)的临床疗效及安全性分析。方法 CEC患者46例46只眼,随机分为两组,对照组22例22只眼,联合组24例24只眼。对照组单纯PDT治疗,联合组行PDT治疗1周后行玻璃体腔内注射贝伐珠单抗1.5 mg(0.06 ml)。两组患者术后1、3、6和12个月随访复查最佳矫正视力、眼底、眼底荧光造影(FFA)、吲哚青绿荧光造影(ICGA)和光学相干断层扫描(OCT)。随访时若发现脉络膜新生血管(CNV)部分闭合或仍有渗漏,联合组再行玻璃体腔注射贝伐珠单抗治疗,最短间隔1个月;对照组再行PDT治疗,最短间隔3个月。比较两组患者治疗前后最佳矫正视力、眼底改变、FFA、ICGA、OCT等,评价其疗效及安全性。结果两组患者视力较治疗前均显著提高。两组患者眼底病灶缩小、出血吸收、视网膜水肿消退。联合组19只眼(79.2%)CNV完全闭合,5只眼(20.8%)CNV大部分闭合,轻微荧光素渗漏;对照组15只眼(68.2%)CNV完全闭合,7只眼(31.8%)CNV大部分闭合,轻微荧光素渗漏。OCT显示两组患者术眼视网膜下液吸收,CNV强反射区域明显缩小;联合组和对照组患者黄斑区视网膜厚度均显著缩小。联合组患者仅接受一次PDT治疗,贝伐珠单抗玻璃体腔注射平均治疗次数1.75次;对照组患者PDT平均治疗次数为1.86次。两组患者治疗过程中及术后随访均未见明显眼部或全身不良反应。结论 PDT或PDT联合玻璃体内注射贝伐珠单抗治疗CEC均安全有效,联合治疗能更有效封闭CNV,促进视网膜渗出及出血的吸收,同时减少PDT治疗次数,减轻患者的经济负担,降低并发症发生。

Photodynamic Therapy Versus Photodynamic Therapy Associaled with Intravitreal Bevacizumab Injection for Central Exudative Chorioretinopathy:a Comparative Study

Objective To compare the clinic therapeutic effect of photodynamic therapy（PDT） versus photodynamic therapy associated with intravitreal bevacizumab injection for central exudative chorioretinopathy（CEC）,and to investigate the safety of treatment. Methods A retrospective review was performed for 46 patients（46 eyes） diagnosed as CEC.Forty-six patients were assigned to receive either PDT associated with intravitreal bevacizumab injection（combined group,n=24） or solo PDT（control group,n=22）.The control group was treated with only PDT.The combined group was treated with an intravitreal injection of bevacizumab（1.5 mg/0.06 ml） 1 week after PDT.The best-corrected visual acuity（BCVA）,examination of the ocular fundus,fluorescence fundus angiography（FFA）,indocyanine green angiography（ICGA） and optical coherence tomography（OCT） were retrospectively performed 1,3,6 and 12 months after treatment.If choroidal neovascularization（CNV） was partly closed or the leakage went on during follow-up,those patients in control group were retreated with PDT and patients in combined group were re-injected with bevacizumab.The changes in BCVA,ocular fundus,FFA,ICGA and OCT were used to evaluate the clinic therapeutic effect and safety before and after treatment in two groups. Results At the final follow-up,the BCVA in combined group was improved significantly comparing with control group.Examination of the ocular fundus showed decrease of lesion area and complete absorption of hemorrhage and retinal edema.In combined group FFA and ICGA showed completely close CNV in 19 eyes（79.2%）,and almost closed CNV in 5 eyes（20.8%） with obvious reduction of fluorescence leakage;in control group FFA and ICGA showed completely close CNV in 15 eyes（68.2%）,and almost closed CNV in 7 eyes（31.8%） with obvious reduction of fluorescence leakage.OCT showed the subretinal fluid absorption and reduction of CNV.In combined and control groups the average macular retinal thickness（MRT） decreased significantly at the final follow-up.The average number of intravitreal injection was 1.75 in combined group and the average number of PDT was 1.86 in control group.There were no ocular or systemic adverse events observed in all patients. Conclusions PDT associated with intravitreal bevacizumab injection and solo PDT are effective and safe for the patients with CEC.The combined therapy can more effectively close CNV and absorb fundus hemorrhage and exudation,and it decreases the incidence of recurred CNV,cut down the charge of patients,and decrease the incidence of the adverse response.