玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉样脉络膜血管病变的视力预后比较

目的 比较玻璃体腔注射雷珠单抗（商品名：Lucentis)与玻璃体腔注射雷珠单抗联合光动力疗法（PDT）治疗息肉样脉络膜血管病变（PCV）的视力预后。方法 回顾性临床研究。临床确诊为PCV的36例患者36只眼分为玻璃体腔注射雷珠单抗（单纯注射）组与玻璃体腔注射雷珠单抗联合PDT（联合治疗）组，每组各18例18只眼。单纯注射组患者玻璃体腔注射10 mg/ml雷珠单抗0.05 ml（含雷珠单抗0.5 mg)，注射后1个月按需给药；联合治疗组患者先行常规PDT治疗，3 d后再给予玻璃体腔注射雷珠单抗，注射方法同单纯注射组。联合治疗3个月后根据检查结果 确定是否需要重复注射治疗。治疗后随访时间至少12个月，观察患者的并发症发生情况；对比分析两组患者治疗前及治疗后最小分辨角对数（logMAR）最佳矫正视力（BCVA）的变化情况。结果 所有患者在治疗及随访过程中无视网膜脱离、持续高眼压、视网膜裂孔、眼内炎、全身不良反应等并发症发生。单纯注射组、联合治疗组平均注射雷珠单抗次数分别为(3.00±0.84)、（1.89±0.68）次；两组平均注射雷珠单抗次数比较，差异有统计学意义（t=4.370，P=0.000）。单纯注射组、联合治疗组患者治疗后1、3个月logMAR BCVA比较，差异无统计学意义（t=0.668、0.940，P＞0.05）。单纯注射组、联合治疗组患者治疗后6、12个月logMAR BCVA比较，差异有统计学意义（t=2.188、2.547，P＜0.05）。末次随访时，单纯注射组、联合治疗组logMAR BCVA均较治疗前明显提高，差异有统计学意义（t=3.351、9.408，P=0.012、0.000）。单纯注射组患眼中，视力提高3只眼，占16.7%；视力稳定13只眼，占72.2%；视力下降2只眼，占11.1%。联合治疗组患眼中，视力提高4只眼，占22.2%；视力稳定13只眼，占72.2%；视力下降1只眼，占5.6%。结论 玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合PDT治疗PCV均可明显提高患者视力。治疗后3个月内两种治疗方式的视力预后无明显差别；治疗后6~12个月，玻璃体腔注射雷珠单抗联合PDT治疗者视力预后优于玻璃体腔注射雷珠单抗治疗者。

Comparison of visual outcomes between intravitreal ranibizumab injection combined with or without photodynamic therapy for polypoidal choroidal vasculopathy

Objective To compare the visual outcomes of treatment with intravitreal ranibizumab alone or in combination with photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). Methods In this retrospective and comparative study, 36 eyes of 36 patients with PCV were enrolled. Eighteen eyes received 0.5 mg (0.05 ml) ranibizumab injection only (simple injection group) and the other 18 eyes underwent combination therapy of ranibizumab injection and PDT (combination treatment group). Intravitreal ranibizumab was given at the third day after PDT. Re-treatment was considered in clinic examination. The minimum re-treatment interval was 3 months for combination therapy and 1 month for ranibizumab. Best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) at baseline and each follow-up visit at 1, 3, 6, 12 month was measured as a primary outcome, and complications also observed in every follow-up. Results No complications occurred in these 36 patients during the treatment or follow-up, such as retinal detachment, sustained high intraocular pressure, retinal holes, intraocular inflammation, and systemic adverse reactions. The average times of ranibizumab injections of simple injection group and combined treatment group were (3.00±0.84) and (1.89±0.68) times respective, and the difference was significant (t=4.370, P=0.000). The logMAR BCVA of the first and third month after initial treatment between two groups were significant different (t=0.668, 0.940;P＞0.05). However, there was no significant difference between them at the 6th and 12th month (t=2.188, 2.547;P＜0.05). In the last follow-up, the logMAR BCVA were improved in simple injection group and combination treatment group compared to the pre-treatment values (t=3.351, 9.408; P=0.012, 0.000). In simple injection group, visual acuity was improved in 3 eyes (16.7%), stable in 13 eyes (72.2%) and decreased in 2 eyes (11.1%). In combination treatment group, visual acuity was improved in 4 eyes (22.2%), stable in 13 eyes (72.2%) and decreased in 1 eyes (5.6%). Conclusions Intravitreal ranibizumab injection and combined with PDT are both effective to improve vision in patients with PCV. Visual acuity was the same between the two treatments in 3 months after initial treatment; however 6 to 12 months after first treatment, patients received PDT combined with intravitreal ranibizumab injection had better visual acuity than those received the intravitreal ranibizumab injection only.