光动力疗法、抗血管内皮生长因子药物玻璃体腔注射及二者联合治疗晚期渗出型老年性黄斑变性疗效观察

摘要

目的 观察光动力疗法(PDT)、抗血管内皮生长因子(VEGF)药物玻璃体腔注射及二者联合治疗晚期渗出型老年性黄斑变性(AMD)的临床效果.方法 临床确诊为晚期渗出型AMD的28例患者32只眼纳入研究.其中,15只眼行PDT或抗VEGF药物单一治疗,17只眼行联合治疗.治疗后随访5～28个月,平均随访时间21个月.治疗后第1、2周以及每一个月行常规视力、眼压和光相干断层扫描(()CT)检查,每3个月行荧光素眼底血管造影( FFA)检查.观察所有患者治疗前后视力、黄斑渗漏及中央视网膜厚度(CRT)的变化及不良反应发生情况.对比分析单一治疗组和联合治疗组平均治疗次数的差异.结果32只眼中,视力提高20只眼,占62.5％;不变9只眼,占28.1％；下降3只眼,占9.4％.黄斑渗漏消失17只眼,占53.1％；减少12只眼,占37.5％；增加3只眼,占9.4％.CRT减少23只眼,占71.8％；增厚9只眼,占28.2％.单一治疗组治疗次数2～7次,平均治疗次数(3.4±0.5)次；联合治疗组治疗次数1～4次,平均治疗次数(2.3±0.2)次.联合治疗组治疗次数明显少于单一治疗组,差异有统计学意义(t=4.005,P＜0.05).所有患者在随访期间均未发生不良反应.结论 PDT、玻璃体腔注射抗VEGF药物及二者联合治疗晚期渗出型AMD均可改善患者病情和视力.联合治疗可减少治疗次数.%Objective To observe the efficacy of monotherapy and combination treatments of photodynamic therapy (PDT) and intravitreal anti- vascular endothelial growth factor (VEGF) drugs for advanced exudative age-related macular degeneration (EAMD).Methods Thirty-two eyes from 28 patients with EAMD were enrolled in this study.Fifteen eyes were treated with PDT or intravitreal anti-VEGF drugs (monotherapy group),while 17 eyes were treated with combination treatments of PDT and intravitreal anti-VEGF drugs (combination group).The follow-up was ranged from 5 to 28 months with a mean of 21 months.Vision and intraocular pressure were measured and optical coherence tomography (OCT) was performed every month after treatment.Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed every 3 months during follow-up period.The changes of visual acuity,leakage in macula lutea and central retinal thickness (CRT) before and after treatment,and adverse events during follow-up period were observed.The mean treatment times of monotherapy and combination group were compared and analyzed.Results Among 32 eyes,visual acuity improved in 20 eyes (62.5％),stabilized in 9 eyes (28.1％) and decreased in 3 eyes (9.4％).The leakage in macula lutea disappeared in 17 eyes (53.1％),decreased in 12 eyes (37.5％) and increased in 3 eyes (9.4％).CRT was reduced in 23 eyes (71.8％),increased in 9 eyes (28.2％).The mean treatment times of the combination group (2.3±0.2)was significantly less than that of monotherapy group (3.4 ± 0.5)(P＜0.05).No adverse events such as secondary retinal hemorrhage,vitreous hemorrhage or endoophthalmitis were found during the follow-up duration.Conclusions Both monotherapy and combination treatments of PDT and intravitreal anti-VEGF drugs for EAMD may improve visual acuity,exudation and macular edema.Combination of PDT and antiVEGF therapy decreases the frequency of retreatment.