目的：评估仅玻璃体腔注射组织纤溶酶原激活剂(TPA)对玻璃体黄斑牵引以及玻璃体腔注射TPA和贝伐单抗对视网膜血管疾病的改善作用。

方法：前瞻性研究。对24例24眼患者进行干预性系统研究。其中5眼玻璃体黄斑牵引综合征(VMT)，19眼视网膜血管疾病包括：糖尿病黄斑水肿(DME)眼，糖尿病性玻璃体出血(VH)眼，视网膜中央静脉阻塞(CRVO)和新生血管年龄相关性黄斑变性眼(AMD)。在注射前及注射1mo后分别进行视力，B超和OCT检查。3眼VMT接受玻璃体腔单次注射TPA50 μg，2眼接受100 μg 注射。19例视网膜血管疾病患者接受玻璃体腔组织纤溶酶原激活剂(50 μg)和贝伐单抗(1.25 mg)联合治疗。

结果：纳入病例中男性10眼视网膜血管疾病和VMT患者平均年龄分别为56.8y 和60.4y。纳入病例中男性10眼(41.7%)，女性14眼(58.3%)。22眼(91.7%)晶状体眼，2眼(8.3%)人工晶状体眼。VMT和视网膜血管疾病的玻璃体后部脱离(PVD)分别为0(0/5)和57.8%(11/19)(P=0.04)。在改善最佳矫正视力(BCVA)和降低黄斑中心凹厚度(CMT)方面，与无PVD眼相比，有PVD眼改善更多。

结论：在VMT患者中，单独玻璃体腔内注射TPA不能成功诱导玻璃体后部完全脱离。玻璃体腔联合注射TPA和贝伐单抗可引起视网膜血管疾病患者玻璃体后部脱离，提高最佳矫正视力以及降低黄斑中心凹厚度。

METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome(VMT)and 19 eyes with retinal vascular diseases including diabetic macular edema(DME), diabetic vitreous hemorrhage(VH), central retinal vein occlusion(CRVO)and neovascular age related macular degeneration(AMD). Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. And 19 eyes with retinal vascular diseases received combined intravitreal TPA(50 μg)and bevacizumab(1.25 mg).

RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56.8y and 60.4y, respectively. Ten patients(41.7%)were male and 14 patients(58.3%)were female. And 22 eyes(91.7%)were phakic and 2 eyes(8.3%)were pseudophakic. The incidence of posterior vitreous detachment(PVD)was 0(0 of 5)and 57.8%(11 of 19)for VMT and retinal vascular diseases, respectively(P=0.04). Improvement of best corrected visual acuity(BCVA)and decrement of central macular thickness(CMT)were significantly greater in PVD positive eyes compared with PVD negative eyes.

CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.