超广角眼底荧光血管造影引导下周边视网膜光凝对缺血型视网膜中央静脉阻塞预后的影响

发布时间：2018-03-14 06:39

本文选题：超广角眼底荧光血管造影　切入点：视网膜中央静脉阻塞　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探索超广角眼底荧光血管造影(ultra-wide field fluorescein angiography,UWFFA)引导下包括周边视网膜无灌注区在内的充分全视网膜光凝(panretinal photocoagulation,PRP)对缺血型视网膜中央静脉阻塞(ischemic central retinal vein occlusion,I-CRVO)患者前房血管内皮生长因子(vascular endothalium growth factor,VEGF)浓度及预后的影响,以期为临床上治疗方案的选择提供指导。方法:纳入缺血型CRVO 30例患者,30只眼,随机分为充分PRP组与传统PRP组,每组15例患者,15只眼。充分PRP组给予抗VEGF治疗及包括周边视网膜在内的PRP,传统PRP组给予抗VEGF治疗及不包括周边视网膜在内的PRP。观察两组患者的前房VEGF浓度、视网膜无灌注区面积(non-perfusion area,NPA)与视盘面积(disc area,DA)的比值、黄斑中心凹厚度(central macular thickness,CMT)、最佳矫正视力(best corrected visual acuity,BCVA)及注药次数,并分析上述指标随时间的变化情况,两组之间的对比情况,及指标之间的相关性。结果:1入组患者在第一、二、三次玻璃体腔注药前等不同时间点之间的前房VEGF浓度、CMT、BCVA均有统计学差异(F=194.60,P0.00001;F=195.49,P0.00001;F=50.40,P0.00001);视网膜激光光凝治疗前后的NPA/DA有统计学差异(t=7.211,P0.00001;t=6.77,P0.00001)。2第一次玻璃体腔注药前,充分PRP组与传统PRP组相比,患者前房VEGF浓度、CMT、BCVA均无统计学差异(t=0.37,P=0.71;t=-0.39,P=0.69;t=-0.15,P=0.88);第二次玻璃体腔注药前,充分PRP组与传统PRP组的前房VEGF浓度、CMT均有统计学差异(t=-25.30,P0.00001;t=-4.87,P=0.00006),BCVA无统计学差异(t=-1.83,P=0.08);第三次玻璃体腔注药前,充分PRP组与传统PRP组的前房VEGF有统计学差异(t=-8.17,p0.00001),cmt、bcva无统计学差异(t=-0.70,p=0.49;t=-1.21,p=0.24)。视网膜激光光凝治疗前,充分prp组与传统prp组npa/da无统计学差异(t=0.19,p=0.85);视网膜激光光凝治疗后,充分prp组与传统prp组npa/da有统计学差异(t=-5.14,p=0.00009)。3充分prp组中,第一、二次玻璃体腔注药前npa/da与vegf均存在直线相关关系(r=0.87,p=0.00002;r=0.62,p=0.02),第一、二次玻璃体腔注药前vegf与cmt均存在直线相关关系(r=0.83,p=0.0001;r=0.67,p=0.006),第一次玻璃体腔注药前vegf与bcva、npa/da与cmt、npa/da与bcva均存在直线相关关系(r=0.80,p=0.0004;r=0.84,p=0.0001;r=0.77,p=0.001)。传统prp组中,第一、二、三次玻璃体腔注药前npa/da与vegf均存在直线相关关系(r=0.93,p=0.000001;r=0.67,p=0.006,;r=0.55,p=0.04),第一、二、三次玻璃体腔注药前vegf与cmt均存在直线相关关系(r=0.82,p=0.0002;r=0.62,p=0.01,;r=0.61,p=0.02),第一、三次玻璃体腔注药前vegf与bcva均存在直线相关关系(r=0.66,p=0.008;r=0.60,p=0.02),第一、二次玻璃体腔注药前npa/da与cmt均存在直线相关关系(r=0.75,p=0.001;r=0.76,p=0.001),第一、二次玻璃体腔注药前npa/da与bcva均存在直线相关关系(r=0.58,p=0.02;r=0.78,p=0.001)。4充分prp组与传统prp组平均注药次数分别为3(3,4)和4(3,5),两组之间存在统计学差异(z=-2.035,p=0.04),充分prp组玻璃体腔注药次数少于传统prp组。结论:1对于缺血型crvo患者,抗vegf药物与激光联合应用能够快速降低眼内vegf浓度,改善视网膜缺血状态,减轻黄斑水肿,提高视力。2传统prp对于周边视网膜无灌注区激光光凝的缺失是黄斑水肿反复发作的重要原因。3uwffa引导下包括周边视网膜在内的充分prp能够更加有效地改善视网膜缺血状态、减轻黄斑水肿、减少复发次数、减轻治疗负担,但短期内提高视力的作用尚不明确。
[Abstract]:Objective: To explore the ultra wide-angle fundus fluorescein angiography (ultra-wide field fluorescein angiography, UWFFA) full panretinal photocoagulation including peripheral retinal non perfusion area, under the guidance of (panretinal photocoagulation, PRP) for ischemic central retinal vein occlusion (ischemic central retinal vein occlusion, I-CRVO) of vascular endothelial growth factor in patients with anterior chamber (vascular endothalium growth factor VEGF), effect of concentration and prognosis, in order for the clinical treatment of choice to provide guidance. Methods: a total of 30 cases of ischemic CRVO patients, 30 eyes were randomly divided into PRP group and traditional full PRP group, each group of 15 patients, 15 eyes. The full PRP group received anti VEGF therapy and including the surrounding the retina, PRP, traditional PRP group received anti VEGF therapy and does not include peripheral retinal, PRP. observation before the real concentration of VEGF of the two groups of patients, no retinal Perfusion area (non-perfusion area, NPA (disc) and optic disc area, DA) the ratio of foveal thickness (central macular, thickness, CMT), best corrected visual acuity (best corrected visual acuity, BCVA) and the number of drug injection, and analysis of changes in these indicators over time, the comparison between the two groups the correlation and between the indexes. Results: 1 patients in first, second, anterior chamber VEGF concentration between the three intravitreous injection before the different time point of CMT, BCVA were statistically difference (F=194.60, P0.00001; F= P0.00001; 195.49, F=50.40, P0.00001); before and after laser photocoagulation on NPA/DA statistical difference (t=7.211, P0.00001; t=6.77, P0.00001).2 first intravitreous injection before the full PRP group compared with the traditional PRP group, anterior chamber VEGF concentration in patients with CMT, there was no significant difference in BCVA (t=0.37, P=0.71; t=-0.39, P=0.69; t=-0.15, P=0.88) Second; intravitreous injection, anterior chamber concentration of VEGF full PRP group and traditional group PRP, CMT were statistically significant (t=-25.30, P0.00001; t=-4.87, P=0.00006), there was no significant difference in BCVA (t=-1.83, P=0.08); third intravitreous injection, full PRP group and traditional group PRP anterior chamber VEGF statistical difference (t=-8.17, p0.00001, CMT), there was no significant difference in BCVA (t=-0.70, p=0.49; t=-1.21, p=0.24). The retinal laser photocoagulation before treatment, no significant difference between the npa/da group and the traditional full PrP group PrP (t=0.19, p=0.85); visual laser net membrane coagulation treatment, there is significant difference in PRP group and fully the traditional PrP npa/da group (t=-5.14, p=0.00009).3 in the PrP group, there were linear correlation between the first, second intravitreous injection of npa/da and VEGF (r=0.87, p=0.00002; r=0.62, p=0.02), there were linear correlation between the first, second intravitreous injection of VEGF and CMT (r=0.83, P=0.0001; r=0.67, p=0.006), the first intravitreous injection of VEGF and BCVA, npa/da and CMT, there was linear correlation between npa/da and BCVA (r=0.80, p=0.0004; r=0.84, p=0.0001; r=0.77, p=0.001). The traditional first, second PrP group, and there were linear correlation between the three intravitreous injection before npa/da with VEGF (r=0.93, p=0.000001; r=0.67, p=0.006; r=0.55, p=0.04), first, second, there were linear correlation between the three intravitreous injection of VEGF and CMT (r=0.82, p=0.0002; r=0.62, p=0.01; r=0.61, p=0.02), there were linear correlation between the first, third intravitreous injection of VEGF and BCVA (r=0.66, p=0.008; r=0.60, p=0.02), there were linear correlation between the first, second intravitreous injection of npa/da and CMT (r=0.75, p=0.001; r=0.76, p=0.001), there were linear correlation between the first, second intravitreous injection of npa/da and BCVA (r=0.58, p=0.02; r=0.78, p=0.001).4 The full PrP group and traditional group PrP average injection times were 3 (3,4) and 4 (3,5), there was significant difference between the two groups (z=-2.035, p=0.04), the full group PrP intravitreal injection is less than the traditional PrP group. Conclusion: 1 for patients with ischemic CRVO, anti VEGF drugs combined with laser application can rapidly reduce the intraocular concentration of VEGF, improve the state of retinal ischemia, alleviate macular edema and improve visual acuity loss.2 PRP for the traditional peripheral retinal non perfusion laser photocoagulation is fully PrP including peripheral retina,.3uwffa an important cause of recurrent macular edema under the guidance can effectively improve the ischemic state and macular edema., reduced relapse frequency, reduce the burden of treatment, but in the short term to improve the visual effect is not clear.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.63

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