摘要
目的观察和评估康柏西普治疗病理性近视脉络膜新生血管(CNV)的有效性和安全性,探讨影响视力预后和玻璃体内注药次数的相关因素。方法回顾性病例研究。临床检查确诊的病理性近视CNV患者47例49眼纳入研究。其中,男12例13眼,女35例36眼。年龄(56.67±13.90)岁,屈光度(-13.64±3.92)D,眼轴长度(29.03±1.36)mm。患者均为首次治疗,采用1+PRN的治疗方案给予所有患眼玻璃体内注射康柏西普0.05 mL(含康柏西普0.5 mg)治疗。均行最佳矫正视力(BCVA)、眼底彩色照相、荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)检查。BCVA检查采用国际标准视力表,记录时换算为最小分辨角对数(logMAR)视力。所有患眼随访时间超过24个月。观察并记录患眼治疗后1个月、3个月、6个月、12个月、24个月BCVA、黄斑中心凹视网膜厚度(CMT)、CNV面积、CNV渗漏面积变化及玻璃体内注药次数;将治疗后24个月logMAR BCVA及总注射针数分别与各基线资料(屈光度、眼轴、病理性近视分期、CNV位置、logMAR BCVA、CMT、CNV面积、CNV渗漏面积)进行Person或Spearman相关分析。结果在24个月随访期内,患眼第1年与第2年平均注射针数分别为(3.51±1.54)次、(0.57±1.02)次,总注射针数为(4.08±1.75)次。与治疗前相比,治疗后1个月、3个月、6个月、12个月、24个月患眼BCVA明显提高,差异均有统计学意义(均为P<0.05)。与治疗前相比,治疗后1个月、3个月、6个月、12个月、24个月患眼CMT明显下降,差异均有统计学意义(均为P<0.05)。与治疗前相比,治疗后3个月、6个月、12个月、24个月患眼CNV面积明显下降,差异均有统计学意义(均为P<0.05)。与治疗前相比,治疗后3个月、6个月、12个月、24个月患眼CNV渗漏面积明显下降,差异均有统计学意义(均为P<0.05)。相关性分析结果显示,治疗后24个月logMAR BCVA与基线屈光度、眼轴、病理性近视分期、CNV位置、CMT、CNV面积均无明显相关(均为P>0.05),但与基线logMAR BCVA、CNV渗漏面积呈正相关(r=0.595、0.319,P=0.000、0.026)。总注射针数与基线屈光度、眼轴、病理性近视分期、CNV位置、CNV面积均无明显相关(均为P>0.05),但与基线CMT、CNV面积、CNV渗漏面积呈正相关(r=0.297、0.440、0.433,P=0.038、0.002、0.002)。所有患者均未出现眼部并发症以及全身不良反应。结论康柏西普治疗病理性近视CNV可以带来较好的视力与解剖形态收益,效果安全有效;末次随访BCVA与基线BCVA、CNV渗漏面积具有正相关性,总注射针数与基线CMT、CNV面积、CNV渗漏面积具有正相关性。
Objective To observe and evaluate the efficacy and safety of Conbercept for the treatment of pathological myopia(PM)with choroidal neovascularization(CNV),and to explore the factors affecting visual prognosis and the number of intravitreal injections.Methods A retrospective case study was conducted on 49 eyes of 47 CNV patients with PM diagnosed by clinical examination.There were 13 eyes of 12 males and 36 eyes of 35 females,with average age of(56.67±13.90)years,mean diopter of(-13.64±3.92)D,and average axial length of(29.03±1.36)mm.All patients were treated for the first time,and received 1+PRN for intravitreal injection of 0.05 mL Conbercept(containing 0.5 mg Conbercept).Best corrected visual acuity(BCVA)detection,fundus color photography,fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were performed.BCVA was detected with international standard visual acuity chart and converted to the minimum resolution logarithm(logMAR)visual acuity.All affected eyes were followed up for more than 24 months to observe and record BCVA,central macular thickness(CMT),CNV area,CNV leakage area and number of intravitreal injections at 1,3,6,12 and 24 months after treatment;for 24 months after treatment,correlation analysis was respectively conducted on logMAR BCVA and total number of intravitreal injections with baseline data(diopter,eye axis,PM stage,CNV location,logMAR BCVA,CMT,CNV area,area of CNV leakage)by Person or Spearman correlation analysis.Results During the 24-month follow-up period,the average number of injections was 3.51±1.54 in the first year,and 0.57±1.02 in the second year,and the total number was 4.08±1.75.Compared with before treatment,BCVA was significantly increased in the affected eyes at 1,3,6,12 and 24 months after treatment,and the differences were statistically significant(all P<0.05).Compared with before treatment,CMT of the affected eyes decreased significantly at 1,3,6,12 and 24 months after treatment,and the differences were statistically significant(all P<0.05).Compared with before treatment,both CNV areas and CNV leakage areas of the affected eyes decreased significantly at 3,6,12 and 24 months after treatment,and the differences were statistically significant(all P<0.05).Correlation analysis showed that logMAR BCVA at 24 months after treatment had no significant correlation with diopter,axial length,PM stage,CNV location,CMT,CNV area at baseline(all P>0.05);but had positive correlation with baseline logMAR BCVA and CNV leakage area(r=0.595,0.319;P=0.000,0.026).The total number of injections had no significant correlation with diopter,axial length,PM stage,CNV location and CNV area at baseline(all P>0.05);but positive correlation with baseline CMT,CNV area and area of CNV leakage(r=0.297,0.440,0.433;P=0.038,0.002,0.002).All patients had no ocular complications or systemic adverse reactions.Conclusion Conbercept is safe and effective for the treatment of PM with CNV and can achieve better vision benefit and anatomical benefit.The last follow-up BCVA has positive correlation with baseline BCVA and CNV leakage area,and the total number of injections has positive correlation with baseline CMT,CNV area and CNV leakage area.
作者
陈丛
闫明
宋艳萍
CHEN Cong;YAN Ming;SONG Yanping(The First School of Clinical Medicine,Southern Medical University,Guangzhou 510080,Guangdong Province,China;The Ophthalmology Center,General Hospital of Central Theater Command,Wuhan 430070,Hubei Province,China)
出处
《眼科新进展》
CAS
北大核心
2020年第6期569-573,共5页
Recent Advances in Ophthalmology
关键词
康柏西普
病理性近视
脉络膜新生血管
最佳矫正视力
荧光素眼底血管造影
Conbercept
pathological myopia
choroidal neovascularization
best corrected visual acuity
fundus fluorescein angiography
