光动力疗法联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变疗效观察

目的 观察光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变（PCV）的安全性和有效性。方法 回顾性系列病例研究。临床确诊为PCV的患者24例24只眼纳入研究。所有患者均行视力、眼底彩色照相、荧光素眼底血管造影（FFA）、吲哚青绿血管造影(ICGA)和光相干断层扫描（OCT）检查。视力检查采用糖尿病视网膜病变早期治疗研究组视力表进行。患者治疗前平均视力为（33.41±19.43）个字母，平均黄斑视网膜厚度（CRT）为（343.63±88.60） μm。所有患者先行常规PDT治疗，72 h后玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml（含雷珠单抗0.5 mg）。根据检查情况确定是否需要重复行单独玻璃体腔注射雷珠单抗或PDT联合玻璃体腔注射雷珠单抗治疗。治疗后平均随访时间为13.1个月。观察统计每只眼的平均治疗次数、患者并发症及全身不良反应的发生情况。对比分析治疗前后患者视力和CRT的变化，以及黄斑区出血及渗出、PCV病灶的渗漏情况。结果 每只眼平均重复玻璃体腔注射雷珠单抗治疗次数为(2.8±1.6)次，平均重复联合治疗次数为(0.4±0.5)次。所有患眼均未出现与治疗相关的并发症和全身不良反应。末次随访时，患眼视力为（44.21±17.24）个字母，较治疗前平均提高10.8个字母。治疗前后视力比较，差异有统计学意义（t=-4.77，P＜0.01）。24只眼中，视力提高11只眼，占45.8%；视力稳定13只眼，占54.2%。眼底检查发现，黄斑区出血、渗出完全吸收7只眼，占29.2%；黄斑区出血、渗出明显减轻17只眼，占70.8%。FFA及ICGA检查发现，荧光渗漏停止17只眼，占70.8%；仍有轻微荧光渗漏7只眼，占29.2%。OCT检查发现，视网膜下积液消退19只眼，占79.2%；视网膜下积液减轻5只眼，占20.8%。患者平均CRT为（171.33±38.06） μm，较治疗前平均降低172.30 μm。治疗前后平均CRT比较，差异有统计学意义（t=11.96，P＜0.05）。结论 PDT联合玻璃体腔注射雷珠单抗治疗PCV安全有效，可提高患者视力，减轻视网膜水肿，停止或减少PCV病灶渗漏。

Combined photodynamic therapy and intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

Objective To observe the efficacy and safety of combined photodynamic therapy (PDT) with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV). Methods Twenty-four PCV patients (24 eyes) were enrolled in this retrospective case study．All patients were assessed by the examinations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart, color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT). The mean visual acuity was (33.41±19.43) letters; the mean macular retinal thickness was (343.63±88.60) μm. Patients received PDT first, and intravitreal injected ranibizumab 0.5 mg (0.05 ml) 72 hours later. Treatments were repeated as a single intravitreal injection of ranibizumab combined with or without PDT if the monthly follow-up indicated that it was necessary. The average follow-up period was 13.1 months. The average treatment times were analyzed for each eye. Systemic and ocular adverse events were observed. Visual acuity, macular retinal thickness and leakage of PCV before and after the treatment were analyzed. Results Intravitreal ranibizumab injections was repeated (2.8±1.6) times per eye on average, and intravitreal injection of ranibizumab combined with PDT was repeated (0.4±0.5) times per eye on average. No systemic and ocular adverse effects were found during and after combined therapy. In the last follow-up, the mean visual acuity of ETDRS was (44.21±17.24) letters, improved by 10.8 letters (t=-4.77, P＜0.01).Visual acuity was improved in 11 eyes (45.8%) and stable in 13 eyes (54.2%). FFA and ICGA showed complete closed PCV in 17 eyes (70.8%), partial closed PCV in 7 eyes (29.2%). OCT image showed that the retinal edema was disappeared in 19 eyes (79.2%) and alleviated in 5 eyes (20.8%). The mean macular retinal thickness was (171.33±38.06) μm, which was 172.30 μm less than that of pre-treatment values (t=11.96, P＜0.05). Conclusion Photodynamic therapy combined with intravitreal ranibizumab injections for PCV is safe and effective, with visual acuity improvement, reduction of retinal edema and PCV leakage.