苦碟子注射液联合光动力疗法与玻璃体内注射Ranibizumab治疗渗出型年龄相关性黄斑变性

发布时间：2018-08-16 11:26

【摘要】：目的观察苦碟子注射液联合光动力疗法(photodynamic therapy,PDT)与玻璃体内注射Ranibizumab治疗渗出型年龄相关性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效。方法41例(41眼)渗出型AMD患者按治疗方法分为两组:联合组21例21眼,给予苦碟子注射液联合PDT与玻璃体内注射Ranibizumab治疗;对照组20例20眼,仅行PDT联合玻璃体内注射Ranibizumab。两组患者治疗后1个月、3个月、6个月、12个月随访,若发现CNV部分闭合或仍有渗漏则再次行玻璃体内注射Ranibizumab。比较两组患者治疗前后视力、眼底改变及并发症等情况。结果两组患者视力均较治疗前显著提高,联合组患者较同期对照组患者的视力显著提高。末次随访时,联合组21眼CNV完全闭合16眼(占76.2%),大部分闭合5眼(占23.8%);对照组20眼CNV完全闭合15眼(占75.0%),大部分闭合5眼(占25.0%)。与治疗前比较,两组患者治疗后1个月、3个月、6个月、12个月中央视网膜厚度与CNV复合体厚度均明显减少,联合组患者较同期对照组患者的减少更明显。所有治疗眼均接受1次PDT治疗,联合组Ranibizumab玻璃体内注射的治疗次数为(1.38±0.50)次,对照组为(1.96±0.83)次。两组患者治疗过程中及术后随访期内均未见明显眼部或全身不良反应。结论苦碟子注射液联合PDT及玻璃体内注射Ranibizumab与PDT联合玻璃体内注射Ranibizumab治疗渗出型AMD的CNV均安全有效;三联治疗能更有效地改善视力、促进视网膜渗出及出血的吸收,同时减少重复治疗次数,减轻患者的经济负担,更具社会效益。
[Abstract]:Objective to observe the clinical effect of photodynamic therapy combined with intravitreous injection of Ranibizumab in the treatment of choroidal neovascularization in patients with exudative age-related macular degeneration. Methods 41 patients (41 eyes) with exudative AMD were divided into two groups according to the treatment method: the combined group (21 cases, 21 eyes) was treated with Kudaizi injection combined with PDT and intravitreous injection of Ranibizumab, and the control group, 20 cases (20 eyes) with PDT combined with intravitreous injection of Ranibizumab. Patients in both groups were followed up for 1 month, 3 months, 6 months and 12 months after treatment. If partial closure or leakage of CNV were found, intravitreous injection of Ranibizumab was performed again. Visual acuity, fundus changes and complications were compared between the two groups before and after treatment. Results the visual acuity of the two groups was significantly improved than that of the control group, and the visual acuity of the combined group was significantly higher than that of the control group. At the last follow-up, CNV was completely closed in 16 eyes (76.2%) in the combined group and in 15 eyes (75.0%) in the control group, mostly in 5 eyes (25.0%), while in the control group, CNV was completely closed in 15 eyes (75.0%) and in the majority in 5 eyes (25.0%). Compared with before treatment, the central retinal thickness and CNV complex thickness in the combined group were significantly decreased after 1 month, 3 months, 6 months and 12 months after treatment, and the decrease of the combined group was more obvious than that of the control group. All the eyes were treated with PDT once. The times of intravitreous injection of Ranibizumab were (1.38 卤0.50) times in the combined group and (1.96 卤0.83) times in the control group. No significant eye or systemic adverse reactions were observed during the treatment and during the follow-up period. Conclusion Kudaizi injection combined with PDT, intravitreous injection of Ranibizumab and PDT combined with intravitreous injection of Ranibizumab are safe and effective in the treatment of CNV of exudative AMD, and triple therapy can improve visual acuity more effectively and promote the absorption of retinal exudation and hemorrhage. At the same time, reduce the number of repeated treatment, reduce the economic burden of patients, more social benefits.
【作者单位】：上海交通大学医学院附属第一人民医院眼科;
【分类号】：R774.5

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