自体RPE与Bruch膜复合体移植联合bevacizumab治疗隐匿性CNV的近期效果

摘要

目的:探讨自体视网膜色素上皮(RPE)与Bruch膜复合体移植联合bevacizumab(Avastin)治疗隐匿性脉络膜新生血管(CNV)的近期效果.方法:选择34例35眼病变范围大同时伴大面积黄斑区视网膜下积血的隐匿性CNV患者,分为A和B组.A组疗法分别为黄斑下积血和CNV取出术、bevacizumab玻璃体腔注射、bevacizumab玻璃体腔注射联合光动力疗法(PDT)、激光光凝.B组为黄斑下积血和CNV取出术基础上,行自体RPE与Bruch膜复合体移植,术后联合bevacizumab玻璃体腔注射.所有患者记录治疗前与治疗结束后随访期间最佳矫正视力(BCVA)、眼压(IOP)、检眼镜下眼底情况、眼底血管造影(FFA和ICGA)、光学相干断层扫描(OCT)、多焦视网膜电图(mfERG)等检查情况.结果:治疗结束后随访11.7±6.5mo,B组BCVA较手术前提高10例10眼(71.43%,10/14),不变2例2眼(14.29%,2/14),下降2例2眼(14.29%,2/14),均未见CNV复发.B组BCVA 4.3±1.1,较其治疗前(3.5±0.4)有提高(P＜0.05),与A组治疗结束后BCVA(3.4±0.3)比较也有提高(P＜0.05).B组OCT后极部视网膜平均厚度236±71μm,较治疗前(371±97μm)有下降(P＜0.05),与A组治疗结束后(364±86μm)比较也有下降(P＜0.05).结论:对于病变范围大同时伴大面积黄斑区视网膜下积血的隐匿性CNV,自体RPE与Bruch膜复合体移植联合bevacizumab玻璃体腔注射治疗有较好近期效果,是挽救此类患者视力的积极手段之一.%AIM: To observe the consequence of transplantation of autologous RPE - Bruch membrane complex and intravitreal injection of bevacizumab (Avastin) for the occult choroidal neovascularization (CNV). METHODS: A retrospective study was performed in 34 patients (35 eyes) with the massive occult CNV accompanied by the wide - ranging subretinal hemorrhage that underwent different treatment and related literatures were reviewed. The 34 patients (35 eyes) were divided to group A (the treatment methods include the macular subretinal hemorrhage and CNV removal surgery, intravitreal injection of bevacizumab, combination of PDT and intravitreal injection of bevacizumab, laser photocoagulation) and group B (transplantation of autologous RPE - Bruch membrane complex and intravitreal injection of bevacizumab). The outcome was measured before and after therapy by best-corrected visual acuity (BCVA), intraocular pressure (IOP), multifocal ERG ( mfERG), optical coherencerntomography (OCT), fluorescein angiography (FFA), indocyanine green angiography (ICGA). Autofluorescence tests were also conducted.rn RESULTS: During 11. 7±6. 5 months of follow-up after the end of therapy, the BCVA of group B was elevated in 10 eyes (71.43% , 10/14), constant in 2 eyes (14.29% , 2/14) and decreased 2 eyes (14.29% , 2/14). Besides, no recurrent CNV in group B was found. The BCVA of group B was 4. 3±1.1, improving significantly compared with 3. 5±0.4 of group B before therapy (P<0.05) and 3.4±0.3 of group A after the end of therapy (P<0. 05). The posterior pole retinal average thickness measured by fast macular scans using OCT of group B was 236±7Vm, decreasing notably compared with 371 ±97 μm of group B before therapy (P<0.05) and 364±86μm of group A after the end of therapy (P<0.05).rnCONCLUSION: The short-term results of transplantation of autologous RPE - Bruch membrane complex and intravitreal injection of bevacizumab are confirmed and it could increase the visual acuity of patients with the massive CNV accompanied by the wide - ranging subretinal hemorrhage. This positive intervention should be noted in order to save the visual function of such patients.