玻璃体腔注射雷珠单抗治疗伴浆液性色素上皮脱离的湿性AMD的临床研究

发布时间：2018-04-27 02:11

本文选题：雷珠单抗 + 浆液性　；参考：《南京医科大学》2016年博士论文

【摘要】：目的观察伴浆液性视网膜色素上皮脱离(sPED)的湿性年龄相关性黄斑变性(wAMD)患者行玻璃体腔注射雷珠单抗3+prn治疗的临床效果。方法回顾性研究了自2011年6月至2014年6月在上海第十人民医院眼科经荧光素眼底血管造影(FFA)及吲哚青绿血管造影(ICGA)检查确诊为伴浆液性PED的湿性AMD患者23例23眼,均接受玻璃体腔注射雷珠单抗3+prn的治疗,注射后每月定期随访:最佳矫正视力(BCVA),最大视网膜色素上皮脱离高度(hPED)、脱离面积(aPED)、脱离容积(vPED),中央视网膜厚度(CFT)。采用配对t检验方法比较治疗前及治疗后12个月各项指标的变化,spearman's相关性分析了解最佳矫正视力与最大视网膜脱离高度、脱离面积、脱离容积、中央视网膜厚度之间的相关性。同时联系该组病人的临床随访结果,探讨了不同治疗方法及随访策略对该病预后的影响。结果随访后发现:23例患者除1例患者未见任何疗效外,其余患者均有不同程度改善。该组患者ETDRS最佳矫正视力由治疗前的46.7±0.58个字母数上升为57.5±0.28个字母数;平均视网膜色素上皮脱离高度由治疗前的350.17±35.73um减低至238.87±36.87um;平均视网膜色素上皮脱离面积由治疗前的5.12±0.69mm2减低至2.74±0.89mm2;平均视网膜色素上皮脱离容积由治疗前的0.81±0.21mm3减低至0.34±0.1mm3,且治疗前后差异均有统计学意义(P0.01);中央视网膜厚度由治疗前的324.56±16.42um变为286.85±18.39um,该差异没有统计学意义(P0.05)。BCVA的改善与hPED、aPED、vPED、CFT等均无相关性。结论玻璃体腔注射Ranibizumab治疗伴sPED的wAMD效果明显。采用3+prn的注射方法能明显减轻患者视网膜色素上皮脱离程度、提高患者视力、改善患者中心视网膜厚度,值得进一步推广应用。
[Abstract]:Objective to observe the clinical effect of vitreous injection of Leizhu monoclonal antibody (3 prn) in patients with wettable age-related macular degeneration with serous retinal pigment epithelial detachment (RPE). Methods from June 2011 to June 2014, 23 eyes of 23 patients with wet AMD with serous PED were examined by fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) in Shanghai Tenth people's Hospital. All patients were treated by intravitreal injection of Lei Zhu McAb (3 prn). The results were as follows: best corrected visual acuity (BCV), maximum retinal pigment epithelium detachment (RPE), detachment area (APE), detachment volume (VPED), central retinal thickness (CCT), and central retinal thickness (CFT). The correlation between the best corrected visual acuity (BCVA) and the maximum retinal detachment height, detachment area, detachment volume and central retinal thickness was analyzed by using paired t test before treatment and 12 months after treatment to analyze the correlation between the best corrected visual acuity and the maximum retinal detachment height, detachment area, detachment volume and central retinal thickness. At the same time, the effect of different treatment methods and follow-up strategies on the prognosis of the disease was discussed. Results after follow up, all 23 patients were improved to some extent except one patient without any curative effect. The best corrected visual acuity of ETDRS in this group increased from 46.7 卤0.58 letters to 57.5 卤0.28 letters before treatment. The mean height of retinal pigment epithelium detachment decreased from 350.17 卤35.73um to 238.87 卤36.87um. the mean area of retinal pigment epithelium detachment decreased from 5.12 卤0.69mm2 to 2.74 卤0.89mm2.The mean volume of retinal pigment epithelium detachment decreased from 0.81 卤0.21mm3 to 0.34 卤0.1mm3. Before and after treatment, the central retinal thickness changed from 324.56 卤16.42um to 286.85 卤18.39um. there was no correlation between the improvement of P0.05U. BCVA and hPEDaPEDvPEDVCFT. Conclusion the effect of intravitreal injection of Ranibizumab on wAMD with sPED is obvious. The injection of 3 prn can obviously reduce the degree of retinal pigment epithelium detachment, improve the visual acuity of the patients, and improve the thickness of the central retina of the patients, which is worthy of further popularizing and application.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R774.5

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