固视方联合抗VEGF治疗湿性老年性黄斑变性的临床观察

发布时间：2018-04-15 09:36

本文选题：湿性老年性黄斑变性 + 固视方　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:观察固视方联合抗VEGF治疗湿性老年性黄斑变性(AMD)的临床疗效。方法:采用回顾性对照研究的方法,将2014年10月至2016年12月在湖北省中医院眼科确诊为湿性AMD的患者45例(50只眼),分为治疗组23例(26只眼),对照组22例(24只眼)。治疗组给予固视方联合局部抗VEGF药物(本研究选用Lucentis)玻璃体腔注射治疗,对照组仅给予Lucentis玻璃体腔注射,每月随访复查,根据视力、OCT、FFA结果决定是否追加治疗,两组均随访6个月,对两组患者的最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)、FFA荧光渗漏、注药次数方面进行评价。结果:治疗组的平均BCVA(logMAR)从基线测量时的0.83±0.21提高到0.15±0.17,对照组从基线0.86±0.27提高到0.46±0.17,采用配对样本t检验可得出两组组内比较p0.05,差异具有统计学意义,说明两组治疗后的BCVA均较治疗前有明显提高。采用独立样本t检验得出治疗1月、2月两组组间比较p0.05,表明两组的平均BCVA变化值差异无统计学意义;治疗3月、4月、5月、6月两组组间比较p0.05,说明两组平均BCVA的变化值差异具有统计学意义。OCT的观察结果显示,治疗组的CMT从基线的358.4±60.1下降到196.0±18.2,对照组从362.0±44.2下降到208.0±11.0,配对样本t检验可得到两组组内的p0.05,差异具有统计学意义,表明两组治疗后的CMT较治疗前明显减少。采用两独立样本t检验得出组间的p0.05,差异无统计学意义,表明两组在治疗后CMT的变化幅度相差不大,但治疗组平均注射Lucentis的次数较对照组少,说明固视方在一定程度上可减轻黄斑区的水肿。FFA检查显示,治疗1、2月采用卡方检验得出两组的CNV闭合情况p0.05,差异具有统计学意义,表明治疗组的CNV闭合情况优于对照组;治疗3、4、5、6月,经卡方检验得出两组的p0.05,差异无统计学意义,说明两组的CNV闭合情况是相近的。从Lucentis的注射次数来看,治疗组的平均注射次数为2.27±0.78,对照组平均注射次数为3.04±0.95,采用独立样本t检验得出p0.05,差异具有统计学意义,表明治疗组的注射次数少于对照组。结论:1.固视方联合抗VEGF治疗和单纯抗VEGF治疗均能显著提高湿性AMD患者的视力。2.固视方能有效改善或稳定抗VEGF治疗后患者的视力。3.固视方在一定程度上减轻黄斑区的水肿,稳定中央黄斑区的厚度。4.固视方联合抗VEGF治疗有延长单纯抗VEGF治疗玻璃体腔注药的间隔时间的趋势,能明显减少抗VEGF治疗的频次。
[Abstract]:Objective: to observe the clinical effect of Gushi prescription combined with anti-VEGF in the treatment of wet age-related macular degeneration (AMDD).Methods: from October 2014 to December 2016, 45 patients with wet AMD were divided into treatment group (23 cases) and control group (22 cases, 24 eyes).The treatment group was treated with Lucentis intravitreal injection combined with local antitumor drugs (Lucentis), and the control group was given Lucentis intravitreal injection only, followed up every month, according to the results of visual acuity and OCTFFA, the patients in the treatment group were given additional treatment, and the patients in the control group were given Lucentis intravitreal injection only.The two groups were followed up for 6 months to evaluate the best corrected visual acuity (BCVA), central macular retinal thickness (CMT) and FFA fluorescence leakage, and the times of injection.Results: the average BCVAg log Mar in the treatment group was increased from 0.83 卤0.21 to 0.15 卤0.17 at baseline and from 0.86 卤0.27 to 0.46 卤0.17 in the control group.The results showed that the BCVA of the two groups after treatment was significantly higher than that before treatment.The independent sample t-test was used to get the comparison between the two groups in 1 month and 2 months, which indicated that there was no significant difference in average BCVA between the two groups.The comparison between the two groups in three months, four months, five months and six months showed that the difference of average BCVA between the two groups was statistically significant.The CMT of the treatment group decreased from 358.4 卤60.1 to 196.0 卤18.2in the baseline, and that of the control group decreased from 362.0 卤44.2 to 208.0 卤11.0.The matched sample t test showed that there was a significant difference between the two groups (p0.05), indicating that the CMT of the two groups after treatment was significantly lower than that before treatment.Using two independent samples t test, the difference between the two groups was not statistically significant, indicating that the change of CMT in the two groups after treatment was not different, but the average number of Lucentis injection in the treatment group was less than that in the control group.The results showed that Gushi Fang could alleviate edema in macular area to some extent. FFA examination showed that after 1 month treatment, the closure of CNV in two groups was obtained by chi-square test (p0.05). The difference was statistically significant, indicating that the closure of CNV in the treatment group was better than that in the control group.In 6 months after treatment, p0.05 of the two groups was obtained by chi-square test. The difference was not statistically significant, indicating that the closure of CNV in the two groups was similar.The average injection times of Lucentis were 2.27 卤0.78 in the treatment group and 3.04 卤0.95 in the control group. The difference was statistically significant by using independent sample t test, indicating that the injection times in the treatment group were less than those in the control group.Conclusion 1.Both the combination of Gushi prescription and anti VEGF therapy and anti VEGF therapy could significantly improve the visual acuity of patients with wet AMD.Gushi prescription can effectively improve or stabilize the visual acuity of patients after VEGF treatment.Gu Shi Fang alleviated the edema of macular area to a certain extent and stabilized the thickness of central macular area. 4.The combination of Gu Shi Fang and anti VEGF has the tendency of prolonging the interval time of intravitreal injection of anti VEGF alone, and can significantly reduce the frequency of anti VEGF therapy.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.5

【参考文献】