玻璃体腔注射Bevacizumab治疗眼底新生血管对黄斑功能的影响分析

发布时间：2018-05-24 15:51

本文选题：Bevacizumab + 眼底新生血管　；参考：《昆明医学院》2010年硕士论文

【摘要】： 目的:研究玻璃体腔注射bevacizumab治疗眼底新生血管术后对黄斑功能的影响,评价其眼内用药安全性。方法:利用Humphrey750型计算机自动视野计,分别于2008年9月至2010年2月在我院接受bevacizumab玻璃体腔注射术(每月一次,连续两月)的43例(48只眼)眼底新生血管患者行术前、术后一月、术后六月SITA快速10-2及黄斑中心凹阈值检测程序检查。检查结果按鼻上、鼻下、颞上和颞下四个象限分别将各个象限中的每一个位点进行编号,比较特定选择区域内(如图1示)视网膜光敏感度(mean sensitivity,MS),平均缺损度(mean defect,MD)、模式标准差(pattern standard deviation,PSD),黄斑阈值(Fovea)以及中心暗点(central scotoma)的变化。应用光学相关断层扫描仪观察黄斑区视网膜形态,并对黄斑区视网膜神经上皮层厚度进行测量,比较术前术后的解剖及功能变化。结果:1.“点对点”比较选择区域内的20个位点,发现18个位点术前术后的变化无统计学意义(p＞0.05),2个位点分贝数的提高具有统计学意义(P＜0.05);2.平均缺损度(MD)由术前-10.12±6.52降低至术后一月-7.91±5.49及术后六月-7.06±4.72,具有统计学意义(P＜0.05);3.模式标准差(PSD)由术前4.69±3.10降低至术后一月4.44±2.83及术后六月4.03±2.89,差异无显著性(P＞0.05);4.黄斑中心凹阈值(Fovea)由术前24.70±5.75提高至术后一月26.75±5.39及术后六月27.85±4.52,具有统计学意义(P＜0.05);5.视野内绝对暗点及相对暗点的数量从术前14.85±9.43及23.15±10.01分别减少至术后一月9.35±7.54及16.25±11.01,术后六月8.10±8.87及14.56±10.31,差异具有统计学意义(p＜0.05)。有三例患者治疗后中心暗点扩大,至末次随访仍高于基线水平;6.最佳矫正视力由术前0.46±0.16提高至术后一月0.56±0.19及术后六月0.61±0.21,有显著性差异(P＜0.01);7.黄斑中心凹厚度(Foveal Thickness)由术前303.69±92.13降低至术后一月278.98±64.80及术后六月255.64±67.53,具有统计学意义,(P＜0.05);8.注药术前和术后六月最佳矫正视力与平均缺损度(MD)、模式标准差(PSD)、黄斑中心凹阈值(Fovea)及黄斑中心凹厚度(Foveal Thickness)间均有相关性(p＜0.05)。结论:1.连续两次玻璃体腔注射bevacizumab(2.5mg)治疗眼底新生血管术后中心视网膜光敏感性提高,黄斑功能普遍提高或趋于平稳。2.有少数病例术后中心暗点扩大,平均缺损度(MD)及模式标准差(PSD)数值提高,表现出视野损伤的进展。
[Abstract]:Objective: to study the effect of intravitreal injection of bevacizumab on macular function after fundus neovascularization. Methods: from September 2008 to February 2010, 43 patients (48 eyes) with fundus neovascularization underwent bevacizumab intravitreal injection (once a month for two months) from September 2008 to February 2010. SITA and macular fovea threshold were examined 6 months after operation. The results were numbered according to each of the four quadrants of the nasal, subnasal, supratemporal and infratemporal quadrants. The changes of retinal light sensitivity, mean defectd, pattern standard deviation, macular threshold and central scotoma were compared in selected regions (Fig. 1). The retinal morphology of macular area was observed by optical correlation tomography and the thickness of retinal neuroepithelial layer in macular area was measured to compare the anatomic and functional changes before and after operation. The result is 1: 1. "Point-to-point" comparison of 20 loci in the selected region showed that there was no significant change in 18 loci before and after operation (p > 0.05), and the increase in the number of decibels at 2 loci was statistically significant (P < 0.05). The MDD decreased from 10.12 卤6.52 before operation to 7.91 卤5.49 at 1 month after operation and 7.06 卤4.72 at 6 months after operation, with statistical significance (P < 0.05). The model standard deviation (PSD) decreased from 4.69 卤3.10 before operation to 4.44 卤2.83 at one month after operation and 4.03 卤2.89 at 6 months after operation, with no significant difference (P > 0.05). The fovea of macular fovea increased from 24.70 卤5.75 before operation to 26.75 卤5.39 in one month and 27.85 卤4.52 in 6 months after operation, which was statistically significant (P < 0.05). The number of absolute and relative dark spots in the visual field decreased from 14.85 卤9.43 and 23.15 卤10.01 to 9.35 卤7.54 and 16.25 卤11.01 in one month after operation, and 8.10 卤8.87 and 14.56 卤10.31 in June after operation. The difference was statistically significant (P < 0.05). In three patients, the central dark spot was enlarged after treatment, and at the last follow-up, it was still above the baseline level of 6. 5%. The best corrected visual acuity increased from 0.46 卤0.16 before operation to 0.56 卤0.19 at one month after operation and 0.61 卤0.21 at 6 months after operation (P < 0.01). The thickness of foveal fossa decreased from 303.69 卤92.13 before operation to 278.98 卤64.80 in one month and 255.64 卤67.53 in 6 months after operation, which was statistically significant (P < 0.05). There was a correlation between the best corrected visual acuity before and six months after injection and MDD, PSDD, fovea and foveal thickness (P < 0.05). Conclusion 1. Two consecutive intravitreous injections of bevacizumaban 2.5 mg) improved the sensitivity of central retina after fundus neovascularization, and the macular function generally improved or tended to be stable. 2. In a few cases, the central dark spot was enlarged, and the mean degree of defect (MDM) and model standard deviation (PSDs) were increased, showing the progress of visual field injury.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

【参考文献】