玻璃体腔注射抗血管内皮生长因子治疗急性视网膜色素上皮炎观察

摘要

Objective To evaluate efficacy and safety of anti-VEGF treatment for acute retinal pigment epitheliitis(ARPE).Methods In this cases control study,15 cases (15eyes) of ARPE from October 2013 to February 2015 were studied.Vision acuity,fundus photographs,FFA and OCT were examined.The patients were divided into:anti-VEGF group and control group,and followed up 2 months.Results The difference in BCVA of two groups at baseline were not significant(P =0.06).BCVA of treatment group was significantly increased than that is the control group after 2 months followed up (P =0.001).Followed up 2 months,8 cases in therapy group showed the impaired IS/OS and RPE layer were restored,however,the impaired IS/OS or RPE layer in control group were not completely restored.FFA also showed hyperfluorescein around macular center.Conclusion OCT and FFA repealed that initial lesion in ARPE located at the area between IS/OS and PRE inner layer.In acute stage,vision decreased associated with transmission of FFA,as well as disruption of IS/OS and PRE inner layer.Anti-VEGF therapy could improve visual acuity of ARPE quickly.%目的 观察玻璃体注射抗血管内皮生长因子治疗急性视网膜色素上皮炎(ARPE)的安全与有效性.方法 临床病例对照研究.选取2013年10月至2015年2个月在深圳眼科医院就诊的ARPE 15例患者的临床资料,进行BCVA,眼底彩色照相,FFA以及OCT检查.根据患眼所接受的治疗分为治疗组与观察组.其中治疗组8例8只眼,观察组7例7只眼.随访2月比较两组BCVA、FFA荧光素渗漏及视网膜光感受器层、RPE的完整性.结果 两组治疗前BCVA分别为(0.53±0.24)和(0.58±0.23),差异无统计学意义(t=2.14,P=0.06).治疗后2个月,两组BCVA为(0.95±0.11)和(0.65±0.20),差异有统计学意义(t=4.46,P=0.001).治疗前FFA显示1 1例11只眼黄斑区斑点状透见荧光,呈“葡萄簇样”改变.4例4只眼动静脉期开始黄斑区斑点弱荧光,周围环形透见荧光,造影晚期可见点状荧光素染色.OCT显示光感受器层(IS/OS)与RPE层间丘状高反射,或该层连续性中断.治疗后2个月,治疗组8例8只眼OCT显示RPE内层丘状高反射消退,中断的RPE内层与IS/OS层反射带恢复,FFA显示环形透见荧光环消失.观察组5例5只眼中断的RPE内层未恢复,而IS/OS层恢复.2例2只眼中断的RPE内层与IS/OS层未恢复,FFA显示环形透见荧光环与簇状高荧光点存在.结论 ARPE急性期视力下降与光感受器层和RPE内层损害相关.对ARPE患者进行抗新生血管玻璃体注射治疗能较快恢复视力及RPE与光感受器层组织解剖结构.