中华眼底病杂志

中华眼底病杂志

病理性近视脉络膜新生血管患眼玻璃体腔注射康柏西普治疗前后的黄斑视功能评价

查看全文

目的评价病理性近视脉络膜新生血管(MCNV)玻璃体腔注射康柏西普治疗前后的黄斑视功能。方法前瞻性、无对照、非随机研究。2017年4月至2018年4月在山西省眼科医院确诊为MCNV并经玻璃体腔注射康柏西普治疗的21例21只眼纳入研究。其中,男性9例9只眼(42.86%),女性12例12只眼(57.14%)。平均年龄(35.1±13.2)岁,平均屈光度(−11.30±2.35)D,平均眼轴长度(28.93±5.68)mm。采用1+PRN的治疗方案给予所有患眼玻璃体腔注射康柏西普0.05 ml(含康柏西普0.5 mg)治疗。治疗前及治疗后每月常规复查随访,每次随访均行BCVA及MAIA微视野检查。对比分析患眼治疗前后BCVA及黄斑整体指数(MI)、平均光敏感度(MS)、固视状态改变情况。固视状态分为稳定固视、相对不稳定固视、不稳定固视3种。治疗前后BCVA、MI及MS比较采用配对样本 t 检验;治疗前后固视状态比较采用 x2 检验。结果观察期内患眼平均注射治疗次数3.5次。治疗前及治疗后1、3、6个月患眼logMAR BCVA分别为0.87±0.32、0.68±0.23、0.52±0.17、0.61±0.57;MI分别为89.38±21.34、88.87±17.91、70.59±30.02、86.76±15.09;MS分别为(15.32±7.19)、(21.35±8.89)、(23.98±11.12)、(22.32±9.04)dB。与治疗前比较,治疗后1、3、6个月患眼BCVA(t=15.32、18.65、17.38,P<0.01)、MS(t=4.08、3.50、4.26,P<0.01)明显提高,差异有统计学意义。治疗前及治疗后1、3、6个月患眼MI比较,差异无统计学意义(t=0.60、2.42、2.58,P>0.05)。治疗前及治疗后1、3、6个月,稳定固视、相对不稳定固视、不稳定固视患眼比例分别为28.57%、47.62%、23.81%,38.10%、47.62%、14.28%,38.10%、52.38%、9.52%及33.33%、57.14%、9.52%。与治疗前比较,治疗后1、3、6个月稳定固视及相对不稳定固视患眼所占比例较治疗前提高,但差异无统计学意义(x2=1.82、1.24、1.69,P>0.05)。结论MCNV患眼经玻璃体腔注射康柏西普治疗后BCVA、MS明显提高。

ObjectiveTo evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.MethodsA prospective, uncontrolled and non-randomized study. From April 2017 to April 2018, 21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study. There were 9 males (9 eyes, 42.86%) and 12 females (12 eyes, 57.14%), with the mean age of 35.1±13.2 years. The mean diopter was −11.30±2.35 D and the mean axial length was 28.93±5.68 mm. All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN). Regular follow-up was performed before and after treatment, and BCVA and MAIA micro-field examination were performed at each follow-up. BCVA, macular integrity index (MI), mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed. The fixation status was divided into three types: stable fixation, relatively unstable fixation, and unstable fixation. The paired-sample t-test was used to compare BCVA, MI and MS before and after treatment. The x2 test was used to compare the fixation status before and after treatment.ResultsDuring the observation period, the average number of injections was 3.5. The logMAR BCVA of the eyes before treatment and at 1, 3, and 6 months after treatment were 0.87±0.32, 0.68±0.23, 0.52±0.17, and 0.61±0.57, respectively; MI were 89.38±21.34, 88.87±17.91, 70.59±30.02, and 86.76±15.09, respectively; MS were 15.32±7.19, 21.35±8.89, 23.98±11.12, 22.32±9.04 dB, respectively. Compared with before treatment, BCVA (t=15.32, 18.65, 17.38; P<0.01) and MS (t=4.08, 3.50, 4.26; P<0.01) were significantly increased in the eyes 1, 3, and 6 months after treatment. There was no significant difference in the MI of the eyes before treatment and at 1, 3, and 6 months after treatment (t=0.60, 2.42, 2.58; P>0.05). Before treatment and at 1, 3, and 6 months after treatment, the proportion of stable fixation were 28.57%, 38.10%, 38.10%, 33.33%;the proportion of relatively unstable fixation were 47.62%, 47.62%, 52.38%, 57.14% and the proportion of unstable fixation were 23.81%, 14.28%, 9.52%, 9.52%, respectively. The proportion of stable fixation and relatively unstable fixation at 1, 3 and 6 months after treatment were higher than that before treatment, but the difference was not statistically significant (x2=1.82, 1.24, 1.69; P>0.05).ConclusionBCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.

关键词: 近视,退行性/并发症; 脉络膜新生血管化/药物疗法; 血管生成抑制剂/治疗应用; 抗体,单克隆/治疗应用; 视野

Key words: Myopia, degenerative/complications; Choroidal neovascularization/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Visual fields

引用本文: 师燕芸, 郑太, 段薇, 谢娟, 郑东萍. 病理性近视脉络膜新生血管患眼玻璃体腔注射康柏西普治疗前后的黄斑视功能评价. 中华眼底病杂志, 2019, 35(2): 166-170. doi: 10.3760/cma.j.issn.1005-1015.2019.02.011 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Iwase A, Araie M, Tomidokoro A, et al. Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study[J]. Ophthalmology, 2006, 113(8): 1354-1362. DOI: 10.1016/j.ophtha.2006.04.022.
2. 丁小燕, 陈冲林. 正确认识近视脉络膜新生血管的临床特征提高其诊断治疗及规范随访水平[J]. 中华眼底病杂志, 2017, 33(6): 564-568. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.002.Ding XY, Chen CL. Understanding the characteristics of myopic choroidal neovascularization to improve its diagnosis and treatment outcome and follow-up strategy[J]. Chin J Ocul Fundus Dis, 2017, 33(6): 564-568. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.002.
3. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
4. Miyake M, Yamashiro K, Akagi-Kurashige Y, et al. Vascular endothelial growth factor gene and the response to anti-vascular endothelial growth factor treatment for choroidal neovascularization in high myopia[J]. Ophthalmology, 2014, 121(1): 225-233. DOI: 10.1016/j.ophtha.2013.06.043.
5. 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. DOI: 10.1016/j.ophtha.2013.10.023.
6. Gharbiya M, Giustolisi R, Allievi F, et al. Choroidal neovascularization in pathologic myopia: intravitreal ranibizumab versus bevacizumab--a randomized controlled trial[J]. Am J Ophthalmol, 2010, 149(3): 458-464. DOI: 10.1016/j.ajo.2009.10.010.
7. Fujii GY, Juan ED, Humayun MS, et al. Characteristics of visual loss by scanning laser ophthalmoscope microperimetry in eyes with subfoveal ehoroidal neovascularization secondary to age-related macular degeneration[J]. Am J Ophthalmol, 2003, 136(6): 1067-1078. DOI: 10.1016/S0002-9394(03)00663-9.
8. Yan YN, Wang YX, Yang Y, et al. Ten-year progression of myopic maculopathy: The Beijing Eye Study 2001-2011[J]. Ophthalmology, 2018, 125(8): 1253-1263. DOI: 10.1016/j.ophtha.2018.01.035.
9. Shih YF, Ho TC, Hsiao CK, et al. Visual outcomes for high myopic patients with or without myopic maculopathy: a 10 year follow up study[J]. Br J Ophthalmol, 2006, 90(5): 546-550. DOI: 10.1136/bjo.2005.081992.
10. Yamashiro K, Tsujikawa A, Nishida A, et al. Determinants of patient satisfaction with photodynamic therapy for neovascular age-related macular degeneration or polypoidal choroidal vasculopathy[J]. Jpn J Ophthalmol, 2007, 51(5): 368-374. DOI: 10.1007/s10384-007-0465-y.
11. Wu Z, Ayton LN, Guymer RH, et al. Comparison between multifocal electroretinography and microperimetry in age-related macular degeneration[J]. Invest Ophthalmol Vis Sci, 2014, 55(10): 6431-6439. DOI: 10.1167/iovs.14-14407.
12. 孙磊, 陶勇. 玻璃体腔注射抗VEGF药物对MCNV和ICNV治疗前后BCVA及mfERG的影响[J]. 国际眼科杂志, 2017, 17(7): 1245-1248. DOI: 10.3980/j.issn.1672-5123.2017.7.11.Sun L, Tao Y. Effect of intravitreal injection of anti VEGF drugs on BCVA and mfERG before and after treatment for MCNV and ICNV[J]. Int Eye Sci, 2017, 17(7): 1245-1248. DOI: 10.3980/j.issn.1672-5123.2017.7.11.
13. Ismael ZF, El-Shazly AAE, Farweez YA, et al. Relationship between functional and structural retinal changes in myopic eyes[J]. Clin Exp Optom, 2017, 100(6): 695-703. DOI: 10.1111/cxo.12527.
14. Laishram M, Srikanth K, Rajalakshmi AR, et al. Microperimetry - a new tool for assessing retinal sensitivity in macular diseases[J]. J Clin Diagn Res, 2017, 11(7): NC08-NC11. DOI: 10.7860/JCDR/2017/25799.10213.
15. Bedell HE, Pratt JD, Krishnan A, et al. Repeatability of Nidek MP-1 fixation measurements in patients with bilateral central field loss[J]. Invest Ophthalmol Vis Sci, 2015, 56(4): 2624-2630. DOI: 10.1167/iovs.15-16511.
16. Maynard ML, Zele AJ, Feigl B, et al. Mesopic Pelli-Robson contrast sensitivity and MP-1 microperimetry in healthy ageing and age-related macular degeneration[J]. Acta Ophthalmol, 2016, 94(8): 772-778. DOI: 10.1111/aos.13112.
17. Vingolo EM, Salvatore S, Domanico D, et al. Visual rehabilitation in patients with myopic maculopathy: our experience[J]. Can J Ophthalmol, 2013, 48(5): 438-442. DOI: 10.1016/j.jcjo.2013.08.004.
18. Wong EN, Mackey DA, Morgan WH, et al. Inter-device comparison of retinal sensitivity measurements: the CenterVue MAIA and the Nidek MP-1[J]. Clin Exp Ophthalmol, 2016, 44(1): 15-23. DOI: 10.1111/ceo.12629.
19. Parodi MB, Triolo G, Morales M, et al. MP1 and MAIA fundus perimetry in healthy subjects and patients affected by retinal dystrophies[J]. Retina, 2015, 35(8): 1662-1669. DOI: 10.1097/IAE.0000000000000504.
20. 吴秋艳, 陈绮, 谭凡, 等. 高度近视患者黄斑区视网膜光敏感度的变化[J]. 中华眼视光学与视觉科学杂志, 2017, 19(3): 146-151. DOI: 10.3760/cma.j.issn.1674-845X.2017.03.005.Wu QY, Chen Q, Tan F, et al. Retinal light sensitivity in different areas of the macula in high myopia[J]. Chin J Ophthalmol Vis Sci, 2017, 19(3): 146-151. DOI: 10.3760/cma.j.issn.1674-845X.2017.03.005.
21. Dolar-Szczasny J, Święch-Zubilewicz A, Mackiewicz J. Macular integrity assessment and fixation analysis in chronic central serous chorioretinopathy[J/OL]. J Ophthalmol, 2018, 2018: 9479848[2018-03-14]. https://dx.doi.org/10.1155/2018/9479848. DOI: 10.1155/2018/9479848.
22. Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia[J]. Br J Ophthalmol, 2003, 87(5): 570-573. DOI: 10.1136/bjo.87.5.570.
23. Mandelcorn MS, Podbielski DW, Mandelcorn ED. Fixation stability as a goal in the treatment of macular disease[J]. Can J Ophthalmol, 2013, 48(5): 364-367. DOI: 10.1016/j.jcjo.2013.05.006.
24. 师燕芸, 梁忠英, 杨继红, 等. 光动力联合玻璃体腔注射Avastin治疗病理性近视脉络膜新生血管后视功能变化[J]. 中华眼视光学与视觉科学杂, 2013, 15(3): 169-173. DOI: 10.3760/cma.j.issn.1674-845X.2013.03.010.Shi YY, Liang ZY, Yang JH, et al. Changes in visual function after photodynamic therapy combined with intravitreal injection of Avastin for choroidal neovascularisation secondary to pathological myopia[J]. Chin J Ophthalmol Vis Sci, 2013, 15(3): 169-173. DOI: 10.3760/cma.j.issn.1674-845X.2013.03.010.