雷珠单抗与PDT联合治疗湿性年龄相关性黄斑变性的临床观察

发布时间：2018-04-13 14:08

本文选题：湿性年龄相关性黄斑变性 + 血管内皮生长因子　；参考：《山东大学》2016年硕士论文

【摘要】：背景和目的年龄相关性黄斑变性(AMD)是致盲的重要疾病,其发生机制尚不明确,通过修正吸烟这一重要环境危险因素及补充抗氧化剂可能干预年龄相关性黄斑变性的发生发展。湿性年龄相关性黄斑变性(wAMD)的特点为促血管生长因子与抑制血管生长因子之间的作用失衡,导致血管内皮生长因子(VEGF)高表达,形成脉络膜新生血管(CNV),尽管在AMD中所占比例不高,但确是患者视力严重丧失的最重要原因。光动力疗法(PDT)可能导致脉络膜灌注不足,使受治疗部位发生明显炎症反应和VEGF表达的增加,有损害长期视力预后的风险和高复发率；抗VEGF药物疗效显著,但频繁注射需承担较大手术风险,且受患者经济水平等因素限制。抗VEGF药物联合PDT治疗在改善视力的同时可能减少患者再治疗次数,本文回顾分析了雷珠单抗联合光动力治疗随访方案治疗wAMD的长期有效性和安全性。方法临床回顾分析了共11例11只眼,每位患者初始行玻璃体腔注射雷珠单抗(IVR) 0.5 mg后7天内联合标准的PDT疗法,此后根据患者复诊情况继续行每月IVR再治疗或者观察。IVR再治疗的标准为：1、黄斑区视网膜厚度增加100μm以上、视网膜下液体、视网膜水肿；2、出现新的视网膜出血或短期内视力下降5个字母时行FA检查有活动性CNV者。前3个月每月随访一次,之后每6个月随访一次,如果自我监测结果提示异常及时门诊复诊。自我监测手段包括：视力和Amsler方格表检查；随诊内容包括：包括远距离最佳矫正视力(BCVA)、眼压(1OP)、裂隙灯眼前节检查、散瞳后的裂隙灯下眼底检查及光学相干断层扫描(OCT),必要时复查FA,吲哚菁绿脉络膜血管造影(ICGA)在联合治疗前及随访期间排除可疑PCV时进行。本研究主要统计分析的数据包括：BCVA.IOP.中心视网膜厚度(CRT)及IVR再治疗次数。结果结果显示在为期18个月的随访中平均IVR再治疗次数为1.55次(0～8次)；在随访的第1、2、3、6、12及18个月相对基线的CRT平均变化值分别为：-136.09±100.61μm、-147.00±110.42μm、-134.91±96.70μm、-145.09±88.51μm、-123.05±118.61μm和-144.82±86.34μm,显示在联合治疗后1个月内的明显下降及在随后保持大致稳定趋势。患者治疗前基线小数视力范围为0.02～0.8,转换后的平均平均logMAR见力为0.85±0.56,对应的平均小数视力为0.1-0.15；联合治疗18个月后,患者的平均logMAR视力为0.72±0.51,较基线值平均提高了相当于ETDRS视力表的7.31±15.00个字母。甚至有部分患者在接受治疗后维持相对良好的视力超过30个月。随访期间没有与治疗相关的严重并发症发生。结论雷珠单抗联合光动力疗法具有降低wAMD临床干预次数并延长疗效的作用,可作为患者治疗选择。
[Abstract]:Background and objective AMDD is an important cause of blindness. The mechanism of AMDs is not clear. It may interfere with the occurrence and development of age-related macular degeneration by modifying smoking as an important environmental risk factor and supplementing antioxidants.Wet age-related macular degeneration (WMD) is characterized by the imbalance between promoting and inhibiting vascular growth factor, which leads to the high expression of vascular endothelial growth factor (VEGF) and the formation of choroidal neovascularization (CNV), although the proportion in AMD is not high.But it is the most important cause of severe loss of vision.Photodynamic therapy (PDT) may lead to insufficient choroidal perfusion and increase the expression of VEGF and inflammatory reaction in the treated site, which has the risk of damaging long-term visual prognosis and high recurrence rate.But the frequent injection needs to bear the bigger operation risk, and is limited by the patient's economic level and so on.Anti- VEGF combined with PDT may reduce the number of retreatments while improving visual acuity. The long-term efficacy and safety of combined photodynamic therapy with Lei Zhu McAb in the treatment of wAMD were retrospectively analyzed.Methods 11 patients (11 eyes) were treated with PDT within 7 days after vitreous intravitreal injection of Tetrazumab (0.5 mg).After that, according to the patient's follow-up, the standard of monthly IVR retreatment or observation. IVR retreatment was 1: 1, the retinal thickness of macular area increased more than 100 渭 m, and subretinal fluid.Retinal edema 2, new retinal hemorrhage or short-term visual acuity decline in 5 letters of FA examination of active CNV.The first 3 months were followed up once a month, and then every 6 months.Self-monitoring methods included: visual acuity and Amsler checkup; follow-up included: BCVA, IOP, slit-lamp anterior segment examination.The fundus examination under slit lamp and optical coherence tomography (Oct) were performed after mydriasis. If necessary, FAA and indocyanine green choroidal angiography (ICGA) were performed before combined treatment and during follow-up.The main statistical data of this study include: BCVA.IOP.Central retinal thickness (CRT) and IVR retreatment times.There was a marked decline and then a general stable trend.Before treatment, the range of visual acuity at baseline was 0. 02 卤0. 8, the mean logMAR after conversion was 0. 85 卤0. 56, the corresponding mean visual acuity was 0. 1-0. 15. After 18 months of combined therapy, the mean visual acuity was 0. 1-0. 15.The average logMAR visual acuity of the patients was 0.72 卤0.51, which was equivalent to 7.31 卤15.00 letters of the ETDRS visual acuity table.Some patients even maintained relatively good vision for more than 30 months after treatment.No severe treatment-related complications occurred during the follow-up period.Conclusion Leizhu McAb combined with photodynamic therapy can reduce the times of clinical intervention and prolong the curative effect of wAMD, so it can be used as the treatment choice for patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R774.5

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