玻璃体腔注射抗VEGF对ARMD脉络膜厚度和睫状后动脉血流影响

Effect of intravitreal injection of anti-VEGF on choroidal thickness and blood flow in posterior ciliary artery in patients with wet ARMD

摘要:

目的：探讨玻璃体腔注射抗血管内皮生长因子(vascular endothelial growth factor，VEGF)对湿性年龄相关性黄斑变性(age related macular degeneration，ARMD)患者脉络膜厚度和睫状后动脉血流的影响。

方法：选择2014-09/2016-12于我院眼科治疗的93例93眼湿性ARMD患者为研究对象，采用抗VEGF玻璃体注射3mo。对比治疗前(T0)、治疗1mo(T1)、治疗2mo(T2)和治疗3mo(T3)时视网膜中心厚度(central retinal thickness，CRT)、中心凹下脉络膜厚度(subfoveal choroidal thickness，SFCT)、最佳矫正视力(best corrected visual acuity，BCVA)、新生血管基底部宽度(choroidal neovascularization，CNV)，以及睫状后动脉血流参数\〖收缩期峰值流速(peak systolic velocity，PSV)、舒张末期血流速度(end diastolic velocity，EDV)和平均血流速度(mV)，以及阻力指数(resistance index，RI)/搏动指数(pulsatility index，PI)\〗的变化。记录随访期间的不良反应。

结果：所有患者均顺利完成玻璃体腔抗VEGF注射。治疗后患者BCVA、CRT、SFCT、CNV逐渐降低，差异有统计学意义(F=72.738、32.333、7.305、957.450，均P<0.05)。不同基线处对比BCVA、CRT、SFCT、CNV：T3F=2.619、1.942、0.820，均P>0.05)； RI指数出现下降，差异有统计学意义(F=25.451，P<0.05)； PI指数逐渐上升，差异有统计学意义(F=8.660，P<0.05)。PI各基线处对比，T3>T2≈T1>T0(“≈”为相当)，RI各基线处对比T3≈T2结论：玻璃体腔注射抗VEGF可有效降低脉络膜厚度，增加睫状后动脉血流灌注，远期效果较好，且不增加治疗风险。

Abstract:

AIM:To investigate the effect of intravitreal injection of anti-vascular endothelial growth factor(VEGF)on choroidal thickness and posterior ciliary artery blood flow in patients with wet age-related macular degeneration(ARMD).

METHODS:A total of 93 wet ARMD patients enrolled into the ophthalmology department in our hospital from September 2014 to December 2016 were selected into our study. The patients were treated with anti-VEGF vitreous injection for 3mo. The central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), best corrected visual acuity(BCVA, LogMAR), choroidal neovascularization(CNV)and parameters of ciliary arterial blood flow \〖systolic peak flow velocity(PSV), end-diastolic blood flow velocity(EDV)and mean blood velocity(mV), resistance index(RI)/pulse index(PI)\〗 before treatment(T0), 1mo after treated(T1), 2mo after treated(T2), 3mo after treated(T3)were recorded and compared. All patients had been followed for 18mo, and side-effect were recorded.

RESULTS: All wet ARMD patients had successfully completed intravitreal anti-VEGF injection. Compared with before treatment, BCVA, CRT, SFCT, and CNV had gradually decreased(F=72.738, 32.333, 7.305 and 957.450, P<0.05)after treatment. BCVA, CRT, SFCT and CNV: T3P<0.05). There had no significant difference in PSV, EDV and mV before and after treatment(F=2.619, 1.942, 0.820, P>0.05). Compared with before treatment, RI index had gradually decreased(F=25.451, P<0.05)and PI index had gradually increased(F=8.660, P<0.05)after treatment. PI: T3>T2≈T1>T0; RI: T3≈T2CONCLUSION: Intravitreal injection of anti-VEGF can effectively reduce choroidal thickness and increase ciliary posterior arterial perfusion, with a good long-term effect and less risk.