玻璃体内注射Avastin治疗黄斑水肿的疗效观察

发布时间：2018-03-29 16:34

本文选题：Avastin　切入点：黄斑水肿　出处：《大连医科大学》2010年硕士论文

【摘要】： 目的：观察玻璃体内注射Avastin治疗黄斑水肿(ME)的疗效。方法：经双目间接检眼镜、光学相干断层扫描(OCT)或(和)荧光素眼底血管造影(FFA)检查确诊黄斑水肿患者共69例76眼,按病因分为视网膜中央静脉阻塞(CRVO)、视网膜分支静脉阻塞(BRVO)及糖尿病性视网膜病变(DR)三组,行玻璃体内注射Avastin 1.25mg/0.05ml。随访2-13个月,观察视力、眼压、晶状体、眼底情况,FFA观察黄斑水肿及毛细血管渗漏情况,OCT检查黄斑水肿情况及黄斑中心视网膜厚度(CMT)。结果：视力的统计结果显示,三组患者治疗前与治疗后1w、1m、2m、3m四个时间点最佳矫正视力的LogMAR值相比均有显著性差异,即治疗后视力显著提高。CRVO所致ME患者治疗后各时间点之间LogMAR值无显著性差异；BRVO所致ME患者治疗后1m与治疗后2m、3m的最佳矫正视力LogMAR值相比存在差异,t值分别为-2.282、-3.000,P值分别为0.031、0.006,即治疗后1m达最好视力,治疗后2m、3m有所下降；DME患者治疗后1 w和治疗后1 m最佳矫正视力的LogMAR值分别为0.57±0.32、0.54±0.27,二者之间存在统计学差异(P＜0.05),即治疗后1m视力优于治疗后1w视力,而治疗后1m、2m、3m三者之间比较无显著性差异。CMT的统计结果显示,三组患者治疗后1m、2m、3m黄斑中心视网膜厚度均较治疗前存在显著性差异,即黄斑中心视网膜厚度较治疗前明显变薄,黄斑水肿明显改善。CRVO所致ME患者治疗后1m与治疗后3m CMT分别为(337.57±35.851)μm、(375.11±23.219)μm,相比较有显著性差异(P＜0.05)；BRVO所致ME患者和DME患者治疗后各时间点CMT值之间差异无统计学意义。OCT图像显示治疗后黄斑视网膜厚度明显变薄。FFA显示治疗后黄斑区荧光素渗漏明显减少,即黄斑水肿明显消退。对眼压的统计结果显示,BRVO所致ME患者及DME患者治疗前后各时间点的眼压之间比较无统计学差异(P＞0.05),CRVO患者治疗后1w较治疗前眼压升高,且有统计学差异(P＜0.05)。11眼在2个月复查时出现视力再度下降,复查FFA结果显示黄斑区视网膜水肿复发,给予玻璃体内Avastin同一剂量重复注射,术后1个月视力恢复,黄斑水肿消退。3眼在治疗后第1d有角膜上皮的小片状剥脱,9眼治疗后出现注射部位的小片状结膜下出血,无眼压严重升高、白内障、眼内炎、视网膜脱离等严重并发症发生。结论：玻璃体内注射Avastin可有效治疗CRVO、BRVO、DR所致的ME,部分患者需重复注药以维持疗效。本研究中未发现与药物有关的严重的眼部及全身不良反应。
[Abstract]:Objective: to observe the effect of intravitreal injection of Avastin on macular edema. Methods: a total of 69 cases (76 eyes) with macular edema were diagnosed by binocular indirect ophthalmoscope, optical coherence tomography (Oct) or / and fluorescein fundus angiography (FFAA). The patients were divided into three groups according to their etiology: central retinal vein occlusion (CRVO), retinal branch vein occlusion (BRVOO) and diabetic retinopathy (Dr). Intravitreous injection of Avastin 1.25 mg / 0.05ml was performed. The visual acuity, intraocular pressure and lens were observed after follow-up for 2-13 months. Macular edema and capillary leakage were observed by FFA. Macular edema and central retinal thickness were examined by Oct. Results: the statistical results of visual acuity showed that the LogMAR values of the best corrected visual acuity (BCVA) in the three groups were significantly different between before treatment and 1 week after treatment. That is, there was no significant difference between the LogMAR values of ME patients after treatment and the LogMAR values of the patients with ME caused by BRVO at 1 m after treatment and 2 mm after treatment respectively. The difference in LogMAR value was -2.282 卤-3.000g / p, respectively, in the patients with ME caused by the improved visual acuity after treatment and the LogMAR values of the patients with ME caused by BRVO at 2 mm and 2 m after treatment, respectively. The visual acuity was 0.031 卤0.006, that is, the best visual acuity was 1 m after treatment. The LogMAR values of the best corrected visual acuity (BCVA) were 0.57 卤0.32 卤0.54 卤0.27 at 1 week after treatment and 1 m after treatment, respectively. There was significant difference between the two groups (P < 0.05), that is, the visual acuity of 1 m after treatment was better than that of 1 week after treatment. The statistical results of CMT showed that there was significant difference in retinal thickness of macular center between the three groups after treatment, that is, the retinal thickness of macular center was significantly thinner than that of before treatment, and there was no significant difference among the three groups after treatment, and the results showed that the retinal thickness of macular center in the three groups was significantly thinner than that before treatment, and there was no significant difference in retinal thickness between the three groups after treatment. Macular edema was significantly improved in patients with ME induced by .CRVO and 3m CMT was 337.57 卤35.851 渭 m after treatment and 375.11 卤23.219 渭 m after treatment, respectively. There was no significant difference in CMT value between ME patients and DME patients after treatment (P < 0.05). Oct image showed no significant difference. FFA showed that the fluorescein leakage in the macular area was significantly decreased after treatment. The statistical results of intraocular pressure showed that there was no significant difference in intraocular pressure between patients with ME and DME before and after treatment (P > 0.05). The visual acuity of 11 eyes was decreased again after 2 months reexamination. The results of FFA showed that retinal edema recurred in macular area, the same dose of intravitreal Avastin was injected repeatedly, and the visual acuity recovered 1 month after reexamination. Macular edema subsided in 3 eyes on the 1st day after treatment, 9 eyes with corneal epithelium had small flake subconjunctival hemorrhage at the injection site after treatment, no serious elevation of intraocular pressure, cataract, endophthalmitis, retinal detachment and other serious complications occurred. Conclusion: intravitreous injection of Avastin is effective in the treatment of CRV / BRVOD Dr. Some patients need repeated injection to maintain the efficacy. No serious eye and systemic adverse reactions related to drugs were found in this study.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.5

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