玻璃体腔注射康柏西普治疗特发性脉络膜新生血管的临床疗效观测

发布时间：2018-01-16 18:21

  本文关键词：玻璃体腔注射康柏西普治疗特发性脉络膜新生血管的临床疗效观测　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 康柏西普 脉络膜新生血管疾病 黄斑中心视网膜厚度

【摘要】：目的:探讨玻璃体注射康柏西普(Conbercept)治疗特发性脉络膜新生血管(Idiopathic choroidal neovascularization,ICNV)的临床疗效及安全性。方法:选取2015年1月至2017年1月于大连医科大学附属第一医院眼科就诊并诊断为ICNV疾病的患者19例(19只眼)纳入研究,男4例,女15例,年龄19～45岁,所有患者均入院行玻璃体腔注入10mg/ml的康柏西普0.05ml(含康柏西普0.5mg)治疗。于治疗后1w、1mo、3mo、6mo、12mo进行随访,行BCVA检查、双眼裂隙灯显微镜检查眼前节、眼压检查、散瞳后裂隙灯下联合+90D前置镜查眼底、彩色眼底照相、光学相干断层成像(Optical coherence tomography,OCT)、荧光素钠眼底血管造影(Fluorescein fundus angiography,FFA)或吲哚青绿血管造影(Indocyanine green angiography,ICGA)检查,重复注射以每次治疗后有无活动性CNV病灶、病灶扩大或新发病灶或黄斑水肿为标准。统计分析比较治疗期间各时间点的最佳矫正视力(Best corrected visual acuity,BCVA)、OCT测量的黄斑中心凹视网膜厚度(Center retinal thickness,CRT)及以外层视网膜(外界膜至RPE/Bruch膜复合体之间的层次)为准线的CNV病灶横截面积、眼部及全身不良反应。结果:确诊为ICNV疾病的患者共19例(19只眼)纳入研究,其中男4例,占21.1%,女15例,占78.9%,年龄21～45岁,平均(32.42±7.78)岁,玻璃体腔注药次数平均(2.58±1.64)次。治疗前患眼平均BCVA为(0.91±0.61)logMAR,治疗后1、3、6、12个月与治疗前比较,患眼平均BCVA均较治疗前基线明显提高,分别为(0.50±0.38,0.51 ±0.36,0.51 ±0.37,0.52±0.35)logMAR,差异均有统计学意义(P=0.003,P=0.005,P=0.005,P=0.008,均为p0.05),治疗后 1 周与治疗前比较以及治疗后时间点两两比较BCVA差异均无统计学意义。治疗前患眼平均CRT值(308.16±85.89)μm,治疗后1周、1月、3月与治疗前比较,患眼平均CRT值均较治疗前(308.16±85.89)μm降低,分别为(275.11±77.03,250.32±48.59,247.37±50.68)μm,差异有统计学意义(P=0.023,P=0.04,P=0.06,均为p0.05),治疗后6月、12月与治疗前比较以及治疗后时间点两两比较CRT差异均无统计学意义。治疗前CNV病灶横截面积为(0.32±0.17)mm2,治疗后1周(0.24±0.16)mm2、1 月(0.18±0.11)mm2相较治疗前(0.32±0.17)mm2与治疗后 1 月(0.18±0.11)mm2相较治疗后1周(0.24±0.16)mm2,均有统计学意义(P=0.010,P=0.002,P=0.034均为p0.05),其余各治疗时间点CNV病灶横截面积的两两比较差异均无统计学意义。19例ICNV注药患者中治疗后有1例眼压高患者,1月后眼压自行下降至正常范围,6例治疗后出现轻度结膜充血,3天内均吸收消失,1例轻度结膜下出血,4天后自行吸收,随访期间均未发生眼内炎、晶体破损、视网膜病变等眼部严重局部并发症及全身不良反应。结论:玻璃体腔内注射康柏西普治疗ICNV疗效显著,短期内明显提高或稳定患者视力,降低患眼CRT,减轻CNV病灶渗漏,减轻黄斑水肿。早期治疗可减少抗血管内皮生长因子药物的注射次数。玻璃体腔内注射康柏西普安全有效,起效迅速,无与治疗相关的不良反应发生。
[Abstract]:Objective: To investigate the Compaq SEPR (Conbercept) injection of vitreous body for the treatment of idiopathic choroidal neovascularization (Idiopathic choroidal, neovascularization, ICNV) the clinical efficacy and safety. Methods: from January 2015 to January 2017 in the First Affiliated Hospital of Dalian Medical University eye clinic and diagnosed 19 cases of ICNV patients (19 eyes) were included in the study, 4 were male, 15 cases were female, aged from 19 to 45 years old, all the patients received intravitreal injection of 10mg/ml 0.05ml (including Compaq Compaq SEPR Xipu 0.5mg) treatment. After treatment, 1W, 1Mo, 3Mo, 6Mo, 12mo were examined by BCVA double slit lamp biomicroscopy, intraocular pressure examination, after mydriasis under the slit lamp with +90D lens color fundus photography, fundus examination, optical coherence tomography (Optical coherence tomography, OCT), fluorescein fundus fluorescein angiography (Fluorescein fundus angiography, FFA) Indocyanine green angiography (Indocyanine green angiography, ICGA), with repeated injection after each treatment with active CNV lesions, lesions enlarged or new lesions or macular edema as the standard statistical analysis. The best corrected visual acuity during treatment at each time point (Best corrected visual acuity, BCVA), macular foveal thickness measurement of OCT (Center retinal thickness, CRT) and in the outer retina (between the outside membrane to the RPE/Bruch membrane complex level) CNV lesion cross-sectional alignment area, ocular and systemic adverse reactions. Results: the diagnosis of ICNV disease in patients with a total of 19 cases (19 eyes) were included in the study, including 4 cases of male 21.1%, female 15 cases, accounting for 78.9%, age 21 to 45 years old, the average (32.42 + 7.78) years old, the average number of intravitreal drug injection (2.58 + 1.64). Before treatment eyes mean BCVA (0.91 + 0.61) logMAR, 1,3,6,12 months after treatment and Before treatment, the average eye BCVA were compared with the baseline before treatment significantly improved, respectively (0.50 + 0.38,0.51 + 0.36,0.51 + 0.37,0.52 + 0.35) logMAR, the differences were statistically significant (P=0.003, P=0.005, P=0.005, P=0.008, all P0.05), 1 weeks after treatment compared with before treatment and after treatment 22 time points of comparison BCVA. There were no significant differences before treatment in eyes with average value of CRT (308.16 + 85.89) m, 1 weeks after treatment, January, March compared with before treatment, the eyes with average CRT values than before treatment (308.16 + 85.89) m decreased, respectively (275.11 + 77.03250.32 + 48.59247.37 + 50.68) m, the difference was statistically significant (P=0.023, P=0.04, P=0.06, all P0.05), in June December after treatment, compared with before treatment and after treatment of the 22 time points of CRT. There were no significant differences before treatment of CNV lesions in cross-sectional area for (0.32 + 0.17) mm2, after 1 weeks of treatment (0.24. 0.16) mm2,1 June (0.18 + 0.11) mm2 compared with before treatment (0.32 + 0.17) after the treatment with mm2 in January (0.18 + 0.11) mm2 in 1 weeks after the treatment (0.24 + 0.16) mm2, were statistically significant (P=0.010, P=0.002, P=0.034 are P0.05), the rest of the treatment time point CNV lesion cross-sectional area of 22 there were no significant differences in.19 cases of ICNV injection in patients after treatment with 1 cases of patients with high intraocular pressure, intraocular pressure after January to drop to the normal range, mild conjunctival hyperemia occurred in 6 patients after treatment, 3 days were absorbed disappeared, 1 cases of mild subconjunctival hemorrhage, 4 days after self absorption, follow-up period were not endophthalmitis, crystal damage, retinopathy and other eye complications of severe local and systemic adverse reactions. Conclusion: the efficacy of intravitreal injection of etanercept treatment of Compaq ICNV significantly in the short term, improved or stable visual acuity, reduce the risk of eye CRT, reduce CNV leakage, reduce macular edema early. Treatment can reduce the number of injections of anti VEGF drugs. Intravitreal injection of Compaq is safe and effective, with rapid onset and no treatment-related adverse reactions.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R773.4
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本文编号：1434272