光动力疗法联合玻璃体腔注射贝伐单抗治疗一例ICL术后病理性近视脉络膜新生血管的临床疗效观察

发布时间：2018-01-24 04:42

本文关键词： 病理性近视脉络膜新生血管可植入型人工晶体光动力疗法贝伐单抗联合治疗　出处：《浙江大学》2012年硕士论文　论文类型：学位论文

【摘要】：病理性近视(pathologic myopia, PM),又称为高度近视、变性性近视,是指屈光度6.0D,眼轴26mm的近视,通常伴有视网膜,脉络膜和巩膜的变性性改变。其眼底改变包括漆裂纹,Fuch's斑,脉络膜视网膜萎缩,脉络膜新生血管(choroidal neovascularization, CNV)等。其中CNV形成是造成病理性近视视力损害的最重要的原因之一。治疗病理性近视CNV的方法包括激光光凝治疗,经瞳孔温热疗法(transpupillary thermotherapy, TTT),光动力学疗法(photodynamic therapy, PDT),手术及药物治疗等。病理性近视由于其屈光度数较高,并不适合行如准分子激光角膜切削术(photorefractive keratectomy, PRK),准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)等角膜屈光手术。目前矫正高度近视较常用的方法是前房或后房型有晶体眼人工晶体(phakic intraocular lenses, PIOLs)植入术。其中由Staar公司生产的可植入型人工晶体(implantable contact lens, ICL)植入术为矫正病理性近视提供了较为安全,有效的解决途径。经过此类手术的病理性近视患者,虽然其屈光状态发生了改变,然而其疾病的性质并没有发生改变。经ICL植入术后的近视患者仍然会出现病理性近视眼底改变。截止到目前为止,没有资料显示ICL植入术后与CNV发病有相关性,该类患者CNV的治疗目前还没有学者进行讨论和研究。我们随访观察浙江大学医学院附属第一医院眼科的一名经ICL植入术后发生CNV的37岁女性患者4年,在经过一次PDT及一次PDT联合玻璃体腔注射贝伐单抗后,通过观察该患者最佳矫正视力(best corrected visual acuity, BCVA)的变化,CNV在光学相干断层扫描(Optical Coherence Tomography, OCT)中形态学变化,CNV在眼底荧光血管造影(fluorescence fundus angiography, FFA)及吲哚青绿血管造影(indocyanine green angiography, ICGA)中的变化情况,进行相关临床治疗疗效分析研究。经过4年的临床观察,该患者左眼在经过一次PDT及一次PDT联合玻璃体腔注射贝伐单抗联合治疗后,病情基本上得到了控制。左眼眼底检查显示左眼黄斑中心凹下新生血管膜区变成不活动的疤痕。BCVA现一直稳定在20/100。ICGA, FFA显示黄斑中心凹区渗漏完全消失。OCT检查显示该患者黄斑区CNV完全变平。治疗过程中无眼部及全身不良事件发生。该例患者的临床随访观察结果显示PDT, PDT联合玻璃体腔注射贝伐单抗可考虑作为ICL术后发生近视性CNV的治疗方法。
[Abstract]:Pathologic myopia, PMX, also known as high myopia, denatured myopia, refers to myopia of 6.0D and 26mm of axis. Often accompanied by degeneration of the retina, choroid and sclera, the fundus changes include lacquer cracks, Fuchus spot, and choroidal retinal atrophy. Choroidal neovascularization. CNV is one of the most important causes of visual impairment in pathological myopia. The methods of treating pathological myopia include laser photocoagulation and transpupillary thermotherapy (TTT). Photodynamic therapy, PDT, surgery and drug therapy. Pathological myopia is not suitable for photorefractive keratectomy (PRK) because of its high diopter. Laser in situ keratomileusis with laser in situ keratomileusis. Corneal refractive surgery such as LASIK.At present, the commonly used methods for correction of high myopia are anterior chamber or posterior chamber type intraocular lens (IOL). Phakic intraocular lenses. The implantable intraocular lens (IOL), produced by Staar, is an implantable contact lens. ICL) implantation provides a safe and effective way to correct pathological myopia. However, the nature of the disease has not changed. Myopia patients after ICL implantation will still have pathological myopia fundus changes. So far. There is no correlation between ICL implantation and the incidence of CNV. The treatment of CNV in this group of patients has not been discussed and studied by scholars. We followed up a 37-year-old female patient who developed CNV after ICL implantation in the first affiliated Hospital of Zhejiang University School of Medicine for 4 years. After one injection of bevacizumab with PDT and one PDT combined with vitreous injection. The best corrected visual acuities (BCVA) were observed. The morphological changes of CNV were observed in optical Coherence tomography (Oct). CNV had fluorescence fundus angiography in fundus fluorescein angiography. FFAA) and indocyanine green angiography (ICGA) on indocyanine green angiography. After 4 years of clinical observation, the patient's left eye was treated with one PDT and one PDT combined with intravitreal injection of bevacizumab. The left eye fundus examination showed that the subcentral foveal neovascularization of the left eye became an inactive scar. BCVA has been stable at 20 / 100.ICGA. FFA showed complete disappearance of macular fovea leakage. Oct showed that the macular area CNV flattened completely. No eye or systemic adverse events occurred during the treatment. The clinical follow-up results showed that PDT, PDT combined with intravitreal injection of bevacizumab could be considered as a treatment for myopic CNV after ICL.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R778.11

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