PDT联合雷珠单抗对PCV合并玻璃体积血患者视力和术后并发症的影响

Effects of photodynamic therapy with Ranibizumab on visual acuity and postoperative complications in patients with PCV complicated with vitreous hemorrhage

摘要:

目的：研究光动力疗法(photodynamic therapy，PDT)联合玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab，IVR)对息肉状脉络膜血管病变(polypoidal choroidal vasculopath，PCV)合并玻璃体积血(vitreous hemorrhage，VH)患者视力、黄斑中心凹厚度(central macular thickness，CMT)和术后并发症的影响。

方法：将71例71眼PCV合并VH患者根据治疗方式不同分为两组，其中观察组(n=43)在玻璃体切割术后采用PDT联合IVR进行治疗，对照组(n=28)则仅用IVR辅助治疗。随访两组患者治疗后第1、3、6mo时最佳矫正视力(best corrected visual acuity，BCVA)、CMT变化和并发症发生情况。

结果：治疗后两组患者BCVA随时间逐渐改善、CMT随时间逐渐降低，组内不同时间差异有统计学意义(P<0.05)，两组患者治疗后同一时间BCVA、CMT差异有统计学意义(P<0.05)； 治疗后观察组CNV病灶闭合情况明显优于对照组，差异有统计学意义(P<0.05)，完全闭合率高于对照组，差异有统计意义(χ²=4.508，P<0.05)； 治疗后观察组出现相关并发症6眼(14%)，对照组5眼(18%)，两组比较差异无统计学意义(P>0.05)。

结论：PDT联合IVR用于PCV合并VH患者玻璃体切除术后治疗有利于促进血管渗出物质吸收和息肉样病灶消退，从而减轻黄斑水肿，改善患者视力并减少术后并发症发生，临床疗效和安全性均值得肯定。

Abstract:

AIM:To explore the photodynamic therapy(PDT)combined with intravitreal injection of Ranibizumab(IVR)on visual acuity, central macular thickness(CMT)and postoperative complications in the treatment of polypoidal choroidal vasculopathy(PCV)complicated with vitreous hemorrhage(VH).

METHODS: Totally 71 cases of patients(71 eyes)with PCV complicated with VH were divided into two groups according to the treatment methods. And observation group(n=43)was given PDT with IVR after vitrectomy, and control group(n=28)was only given IVR adjuvant treatment. The best corrected visual acuity(BCVA), CMT and postoperative complications were followed up at the 1^st, 3^rd and 6^th month after treatment.

RESULTS: After treatment, the BCVA in the two groups was gradually improved while the CMT was gradually decreased with time, and the difference within-groups at different times was statistically significant(P<0.05), and there were statistically significant differences in BCVA and CMT between the two groups at the same time after treatment(P<0.05). After treatment, the closure of CNV lesion in observation group was significantly better than that in control group(P<0.05), and the complete closure rate was higher than that in control group(χ²=4.508, P<0.05). There was 6 cases(14%)of related complications in observation group after treatment and 5 cases(18%)in control group, and there was no statistically significant difference between the two groups(P>0.05).

CONCLUSION: PDT combined with IVR for patients with PCV and VH after vitrectomy is beneficial to promote the absorption of vascular exudate and the elimination of polypoid lesions, thus reducing macular edema, improving the visual acuity and reducing postoperative complications. And its clinical efficacy and safety are worthy of recognition.