目的：观察年龄相关性黄斑变性(age-related macular degeneration，ARMD)患者在接受雷珠单抗联合光动力治疗疗效欠佳后加用ω-3多不饱和脂肪酸的疗效。

方法：选取2015-02/2017-01在我院接受治疗的年龄相关性黄斑变性患者92例122眼，所有患者均给予眼内雷珠单抗注射联合光动力治疗，根据接受光敏感剂量不同分为半剂量组(45例60眼，接受半剂量维替泊芬3mg/m²)和全剂量组(47例62眼，接受全剂量维替泊芬6mg/m²)，治疗后随访1、3mo。治疗3mo后将出现脉络膜新生血管渗漏(choroidal neovascularization，CNV)或渗漏加重的30例41眼患者按随机数字表的方法分为对照组14例20眼、试验组16例21眼，所有患者均继续接受雷珠单抗联合光动力治疗，维替泊芬剂量按3mg/m²，其中试验组患者加用ω-3不饱和必须脂肪酸软胶囊(2次/d，1粒/次，疗程6mo)，治疗后随访1、3、6mo。随访过程中观察所有患者的最佳矫正视力(best corrected visual acuity，BCVA)变化、黄斑部视网膜厚度(central macular retinal thickness，CRT)、眼压、CNV渗漏情况和雷珠单抗注射平均次数，并统计不良反应发生情况。

结果：半剂量组和全剂量组在治疗前及治疗后1、3mo的BCVA、CRT、眼压和治疗后3mo的CNV总有效率比较，差异均无统计学意义(P>0.05)，而治疗后1、3mo半剂量组雷珠单抗注射次数(1.1±0.8、1.6±1.2次)低于全剂量组注射次数(1.6±1.1、2.5±1.7次)，差异具有统计学意义(P<0.05)。治疗后1、3、6mo，试验组的BCVA和CNV总有效率高于对照组，CRT和雷珠单抗注射次数均低于对照组，差异均具有统计学意义(P<0.05)，所有患者并没有发生与治疗有关的严重不良反应。

结论：运用雷珠单抗联合半剂量维替泊芬光动力治疗年龄相关性黄斑变性患者安全有效，联合ω-3多不饱和脂肪酸可提高治疗疗效。

METHODS: Ninety-two cases(122 eyes)of patients with age-related macular degeneration in our hospital from February 2015 to January 2017 were selected as the subjects. All patients were given intravitreal ranibizumab injection combined with photodynamic therapy, according to the received light sensitive dose were randomly divided into half dose group(45 eyes of 60 cases)and full dose group(47 eyes of 62 cases), half dose group received half dose verteporfin(3mg/m²), the full dose group received full dose verteporfin(6mg/m²). The patients were followed up for 1mo, 3mo after treatment. After 3mo treatment, 41 eyes of 30 patients paitents who got choroidal neovascularization(CNV)leakage again or leakage increased were randomly divided into control group of 14 cases(20 eyes), experimental group of 16 cases(21 eyes). All patients were treated with ranibizumab combined with half dose verteporfin(3mg/m²), photodynamic therapy. The experimental group were added with ω-3 polyunsaturated fatty acids soft capsule(twice per day, 1 tablets per time, period of 6mo). All patients were followed up at 1, 3 and 6mo after treatment.best corrected visual acuity(BCVA), central macular retinal thick(CRT), intraocular pressure, total effective rate of CNV, the average number of injections of ranibizumab and adverse reactions were observed during the follwed up.

RESULTS: The BCVA, CRT, intraocular pressure before and after 1,3mo treatment and the total efficiency of CNV of half dose group were no statistical differences with the full dose group(P>0.05). The number of times ranibizumab injection of half dose group(1.1±0.8, 1.6±1.2)were lower than that in the full dose group(1.6±1.1, 2.5±1.7)at 1 and 3mo after treatment, the differences were statistically significant(P<0.05). The BCVA and CNV in experimental group was higher, CRT and ranibizumab injection times were lower than that in the control group at 1,3 and 6mo after treatment, the differences were statistically significant(P<0.05). No serious adverse reactions related treatment were occurred in all patients.

CONCLUSION: It is safe and effective to treat patients with age-related macular degeneration by ranibizumab combined with half dose photodynamic therapy. The combination of ω-3 polyunsaturated fatty acids can improve the therapeutic effect.