目的：观察高度近视脉络膜新生血管抗VEGF治疗期间的黄斑中心凹下的脉络膜厚度(subfoveal choroidal thickness，SFCT)变化，确定临床与视力预后相关的脉络膜参数。

方法：前瞻性、开放性研究。临床确诊病理性近视脉络膜新生血管患者50例50眼纳入研究。采用国际标准视力表、糖尿病视网膜病变早期治疗研究(ETDRS)视力表测量矫正视力，同时行眼压、检眼镜、眼底照相、荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)及三面镜作相应检查。治疗前患眼EDTRS视力表视力0～69个字母，平均视力29.69±13.46个字母。所有患眼行玻璃体腔注射雷珠单抗0.05mL，每月随访，观察抗VEGF治疗期间的黄斑中心凹下的脉络膜厚度变化、确定与视功能相关的脉络膜参数。

结果：所有患者平均玻璃体腔注射2.47±2.23次。末次随访时平均矫正视力较治疗前提高13.62±8.98个字母，差异有统计学意义(t=6.69，P<0.05)； 治疗前、治疗后1、6、12mo，患眼平均SFCT分别为81.48±61.62、79.63±60.98、77.92±61.26、78.34±59.48μm，较治疗前分别降低了2.09±8.93、3.68±7.42、3.16±6.95μm。治疗后1mo平均SFCT与治疗前比较，差异无统计学意义(t=0.95，P>0.05)； 治疗后6、12mo平均SFCT与治疗前比较，差异有统计学意义(t=2.34、2.61，P<0.05)。24眼(48%)复发，平均每眼复发1.39±1.23次，SFCT自治疗后1mo的75.7±51.6μm到复发时的84.4±55.9μm(比治疗后1mo的厚度增加11.5%)，差异有统计学意义(P<0.05)。26眼(52%)无复发眼，治疗后1mo 85.3±52.7μm，6mo 83.6±50.5μm及12mo 84.2±54.2μm ，各时间点SFCT两两比较，差异均无显著的改变(P>0.05)。随访期间未发现治疗相关的全身及眼部严重并发症。

结论：玻璃体腔注射ranibizumab治疗病理性近视脉络膜新生血管疗效显著、安全性高； 抗VEGF治疗(雷珠单抗注射)使病理性近视脉络膜新生血管患眼SFCT下降，而CNV复发时表现为SFCT增厚，SFCT的增厚可能是CNV活动期的评估指标。

AIM:To observe the change of subfoveal choroidal thickness(SFCT)after intravitreal injections of anti-vascular endothelial growth factor monoclonal antibody Ranibizumab in patients with choroidal neovascularization(CNV)secondary to pathologic myopia(PM)and to research the relation between visual acuity and SFCT.

METHODS:This was a prospective, contrast, open-label study.Fifty pathologic myopia patients with CNV(50 eyes)were recruited in this study. Before the injection,best-corrected visual acuity detected by visual chart from Early Treatment of Diabetic Retinopathy Study(ETDRS),non-contact tonometer,ophthalmoscope,fundus photography, fundus fluorescein angiograph(FFA)and optical coherence tomography(OCT)examination were necessary. All affected eye were treated with intravitreal ranibizumab 0.05mL. Following up for 12mo, the changes of visual acuity and SFCT were compared before and after treatment, also the relation between them.

RESULTS:All eyes received an average of 2.47±2.23 injections,the final vision of follow-up increased by 13.62±8.98 letters than that before(t=6.69,P<0.05). The SFCT before therapy, 1, 6 and 12mo after treatment were 81.48±61.62, 79.63±60.98, 77.92±61.26 and 78.34±59.48μm and respectively decreased by 2.09±8.93, 3.68±7.42, 3.16±6.95μm compare to pre-treatment.The difference on SFCT at 1mo was not significant compared to before treatment(t=0.95, P>0.05).While after 6 and 12mo,the differences were significant(t=2.34, 2.61; P<0.05). Twenty-four eyes(48%)were with recurrence, mean recurrence times were 1.39±1.23. The SFCT increased from 75.7±51.6μm at 1mo to 84.4±55.9μm(by 11.5%)when recurred, there were significant differences(P<0.05). Twenty-six eyes(52%)were not with recurrence. The SFCT at 1, 6 and 12mo after treatment were 85.3±52.7, 83.6±50.5 and 84.2±54.2μm, there were no significant differences with multiple comparison(P>0.05).There were no serious systemic or local side effects during the follow up.

CONCLUSION:Intravitreal ranibizumab for CNV secondary to pathologic myopia is safe and can improve the visual acuity.Intravitreal injections of ranibizumab can induce SFCT reduction for CNV secondary to pathologic myopia.We hypothesized that increase of SFCT may be one of evaluation index for CNV activity.

浙江省卫生厅医药卫生一般研究计划(No.2013KYA186)