山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (2): 68-71.doi: 10.6040/j.issn.1673-3770.0.2021.059
张陶然,王薇,李明铭,黄映湘
ZHANG Taoran, WANG Wei, LI Mingming, HUANG Yingxiang
摘要: 目的 观察玻璃体腔内注射雷珠单抗(IVR)治疗病理性近视脉络膜新生血管(mCNV)的有效性与安全性,同时观察患者黄斑中心凹下脉络膜厚度变化。 方法 回顾性病例系列研究。将2014年11月至2018年12月诊断为初发活动期mCNV并接受IVR的38例42眼纳入研究。所有患者采取IVR 1针初始治疗联合按需注射(1+PRN)的治疗方案,按照患者随访结束时接受IVR的治疗次数分为单次治疗组与重复治疗组两组。观察两组术前及随访结束时研究对象最佳矫正视力、黄斑中心凹下方脉络膜厚度等方面的差异。 结果 重复治疗组雷珠单抗注射次数(3.77±1.21)次,单次治疗组基线脉络膜厚度(59.15±10.57)μm,重复治疗组基线脉络膜厚度(49.33±12.76)μm,二者比较差异有统计学意义(P=0.023);重复治疗组重复治疗前脉络膜厚度增加至(55.22±7.63)μm,重复治疗组基线脉络膜厚度与重复治疗前脉络膜厚度无统计学差异(P=0.131)。 结论 雷珠单抗玻璃体腔内注射1+PRN的治疗方案可有效的治疗病理性近视脉络膜新生血管。基线脉络膜厚度更薄的患者需要重复治疗的可能性更大。
中图分类号:
[1] Xie SQ, Fang YX, Du R, et al. Role of dilated subfoveal choroidal veins in eyes with myopic macular neovascularization[J]. Retina, 2021, 41(5): 1063-1070. doi:10.1097/IAE.0000000000002970. [2] Coco-Martin RM, Belani-Raju M, de la Fuente-Gomez D, et al. Progression of myopic maculopathy in a Caucasian cohort of highly myopic patients with long follow-up: a multistate analysis[J]. GraefesArch Clin Exp Ophthalmol, 2021, 259(1): 81-92. doi:10.1007/s00417-020-04795-5. [3] Ohno-Matsui K, Ikuno Y, Lai TYY, et al. Diagnosis and treatment guideline for myopic choroidal neovascularization due to pathologic myopia[J]. Prog Retin Eye Res, 2018, 63: 92-106.doi:10.1016/j.preteyeres.2017.10.005. [4] Kasahara K, Moriyama M, Morohoshi K, et al. Six-year outcomes of intravitreal bevacizumab for choroidal neovascularization in patients with pathologic myopia[J]. Retina, 2017, 37(6): 1055-1064.doi:10.1097/IAE.0000000000001313. [5] Toto L, di Antonio L, Costantino O, et al. Anti-VEGF therapy in myopic CNV[J]. Curr Drug Targets, 2021, 22(9): 1054-1063. doi:10.2174/1389450122999210128180725. [6] Karagiannis D, Kontadakis G, Kaprinis K, et al. Treatment of myopic choroidal neovascularization with intravitreal ranibizumab injections: the role of age[J]. Clin Ophthalmol, 2017, 11: 1197-1201. doi:10.2147/opth.s135174. [7] Wang HY, Tao MZ, Wang XX, et al. Baseline characteristics of myopic choroidal neovascularization in patients above 50 years old and prognostic factors after intravitreal conbercept treatment[J]. SciRep, 2021, 11(1): 7337. doi:10.1038/s41598-021-86835-6. [8] Cohen SY, Tabary S, El Ameen A, et al. Vascular remodeling of choroidal neovascularization in older myopic patients treated with ranibizumab[J]. Albrecht Von Graefes Arch Fur Klinische Und ExpOphthalmol, 2019, 257(3): 485-493. doi:10.1007/s00417-018-04205-x. [9] Borrelli E, Battista M, Vella G, et al. Three-year OCT predictive factors of disease recurrence in eyes with successfully treated myopic choroidal neovascularisation[J]. Br J Ophthalmol, 2021: bjophthalmol-bjophtha2020-318440. doi:10.1136/bjophthalmol-2020-318440. [10] Coelho J, Ferreira A, Abreu AC, et al. Choroidal neovascularization secondary to pathological myopia—macular Bruch membrane defects as prognostic factor to anti-VEGF treatment[J]. Graefes ArchClin Exp Ophthalmol, 2021. doi:10.1007/s00417-021-05142-y. [11] Ahn SJ, Park KH, Woo SJ. Subfoveal choroidal thickness changes following anti-vascular endothelial growth factor therapy in myopic choroidal neovascularization[J]. Invest Ophthalmol Vis Sci, 2015,56(10): 5794-5800. doi:10.1167/iovs.14-16006. [12] Xie JM, Chen QY, Yu JY, et al. Morphologic features of myopic choroidal neovascularization in pathologic myopia on swept-source optical coherence tomography[J]. Front Med(Lausanne), 2020, 7: 615902. doi:10.3389/fmed.2020.615902. [13] Melzer C, Ziemssen F, Eter N,. Design and baseline characteristics of the help study: an extended and long-term observation of pathological myopia in caucasians[J]. Ophthalmologica, 2018, 240(3): 167-178. doi: 10.1159/000489180. [14] Wang Y, Hu ZL, Zhu TP, et al. Optical coherence tomography angiography-based quantitative assessment of morphologic changes in active myopic choroidal neovascularization during anti-vascularendothelial growth factor therapy[J]. Front Med(Lausanne), 2021, 8: 657772. doi:10.3389/fmed.2021.657772. [15] Ahn SJ, Woo SJ, Kim KE, et al. Association between choroidal morphology and anti-vascular endothelial growth factor treatment outcome in myopic choroidal neovascularization[J]. Invest Ophthalmol Vis Sci, 2013, 54(3): 2115-2122. doi: 10.1167/iovs.12-11542. [16] Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study[J]. Ophthalmology, 2015, 122(6): 1220-1227.doi:10.1016/j.ophtha.2015.01.025. [17] 刘志高, 王淑雅, 韩旭光, 等. 增殖性糖尿病视网膜病变术前玻璃体腔应用阿柏西普的时机及其疗效观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 99-103. doi:10.6040/j.issn.1673-3770.0.2020.250. LIU Zhigao, WANG Shuya, HAN Xuguang, et al. Preoperative timing and the effect of intravitreal aflibercept injection for proliferative diabetic retinopathy patients[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 99-103. doi:10.6040/j.issn.1673-3770.0.2020.250. [18] Tan NW, Ohno-Matsui K, Koh HJ, et al. Long-term outcomes of ranibizumab treatment of myopic choroidal neovascularization in east-Asian patients from the radiance study[J]. Retina, 2018, 38(11): 2228-2238. doi:10.1097/iae.0000000000001858. [19] Tufail A, Narendran N, Patel PJ, et al. Ranibizumab in myopic choroidal neovascularization: the 12-month results from the REPAIR study[J]. Ophthalmology, 2013, 120(9): 1944-5.e1.doi:10.1016/j.ophtha.2013.06.010. [20] Gabrielle PH, Nguyen V, Creuzot-Garcher C, et al. Vascular endothelial growth factor inhibitors for predominantly Caucasian myopic choroidal neovascularization: 2-year treatment outcomes in clinical practice: data from the Fight Retinal Blindness Registry[J]. Acta Ophthalmol, 2021. doi:10.1111/aos.14893. [21] Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692.e2. doi:10.1016/j.ophtha.2013.10.023. [22] Chen YX, Sharma T, Li XR, et al. Ranibizumab versus verteporfin photodynamic therapy in Asian patients with myopic choroidal neovascularization[J]. Retina, 2019, 39(10): 1985-1994. doi:10.1097/iae.0000000000002292. [23] Xiao H, Zhao XJ, Li SS, et al. Risk factors for subretinal fibrosis after anti-VEGF treatment of myopic choroidal neovascularisation[J]. Br J Ophthalmol, 2021, 105(1): 103-108. doi:10.1136/bjophthalmol-2019-315763. |
[1] | 顾冉冉,李凤娇,焦万珍,崔艳艳,赵博军. 卵磷脂络和碘胶囊辅助治疗视网膜静脉阻塞的临床疗效研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 46-50. |
[2] | 任雨馨赵博军. 病理性近视脉络膜新生血管的诊断与治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 157-162. |
[3] | 傅强,王红星. 眼缺血综合征患者脉络膜厚度的分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 60-63. |
[4] | 周学义,李一鸣,王美菊,张苑苑,张历浊. 25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 87-89. |
[5] | 靳琳,潘庆敏,胡磊. 玻璃体腔注射雷珠单抗治疗CSME及NCSME的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 96-98. |
[6] | 严槟,尹小芳,叶祖科,卢彦,洪剑威. 玻璃体腔注射雷珠单抗联合GLP治疗BRVO-ME的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 110-113. |
[7] | 赵露,谢国丽,王艳玲. 玻璃体腔注射雷珠单抗对湿性年龄相关性黄斑变性患者眼血流动力学的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 101-104. |
[8] | 柴雪荣, 张士玺, 陶钰, 申家泉. 玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的效果评价[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 72-75. |
[9] | 张营春, 杜祥阁, 颜昕, 王翠, 赵博军. 尼古丁对人RPE细胞及HUVEC的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 74-80. |
[10] | 龚斌, 范传峰, 王玉. 抗VEGF药物(雷珠单抗)治疗不同病程湿性年龄相关性黄斑变性62例[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 58-61. |
[11] | 訾雨梦1,王玉2,范传峰2,舒湘汶2,吴昌龙2. 玻璃体腔注射治疗不同病程两组特发性脉络膜新生血管病变[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 63-66. |
|