玻璃体腔注射康柏西普治疗高度近视患者脉络膜新生血管

Short-term effects of intravitreal Conbercept for choroidal neovascularization secondary to high myopia

摘要:

目的：观察玻璃体腔注射康柏西普治疗高度近视(high myopia，HM)患者黄斑脉络膜新生血管(choroidal neovascularization， CNV)的短期效果，评估康柏西普治疗高度近视性CNV的临床疗效和安全性。

方法：收集2016-04/2018-02于我院眼科确诊为HM性CNV患者19例19眼，其中男8例8眼，女11例11眼； 年龄35～73(平均55.40±11.75)岁； 屈光度-19.00～-7.50(平均-12.70±3.23)D，均给予玻璃体腔注射康柏西普0.5mg/0.05mL，1次/mo，连续治疗3mo。治疗前记录患者年龄、性别、全身疾病、眼压及最佳矫正视力(best corrected visual acuity，BCVA)，并行眼底荧光血管(fundus fluorescein angiography，FFA)造影观察CNV渗漏情况，应用光学相干断层扫描(optical coherence tomography，OCT)测量黄斑中心区厚度(central macular thickness，CMT)。随访并观察记录每次治疗后1d，1wk，1mo的BCVA和眼压，以及每次治疗后1wk，1mo的CMT，并结合治疗前与末次玻璃体腔注药后1mo FFA、BCVA及CMT变化，评价临床疗效，并注意用药后发生的不良反应。应用SPSS17.0软件统计分析玻璃体腔注射康柏西普治疗HM性CNV患者各项指标差异。

结果：治疗后19例患者平均BCVA(LogMAR)和平均CMT均较治疗前明显改善。末次玻璃体腔注药后1mo，患者平均BCVA(LogMAR)由治疗前基线值0.98±0.29改善为0.64±0.16，且每月治疗后各个时间点平均BCVA(LogMAR)值与治疗前基线值相比均有改善，且差异均有统计学意义(P<0.05)。末次玻璃体腔注药后1mo，患者平均CMT由治疗前基线值324.9±55.6μm降低至248.7±17.7μm，且每次治疗后各个时间点平均CMT较治疗前基线值下降，差异均有统计学意义(P<0.05)。而患者每次玻璃体腔注药治疗后各个随访时间点平均BCVA及CMT两两比较差异均无统计学意义。治疗后2眼出现结膜下出血，且在治疗后2wk完全吸收，其他患者均未发生眼压升高、并发性白内障、眼内炎、视网膜脱离等并发症。

结论：玻璃体腔注射康柏西普治疗HM性CNV安全有效，可以提高患者最佳矫正视力，降低CMT，在结构和功能上达到治疗HM性CNV的目的，且首次治疗效果较明显。

Abstract:

AIM: To evaluate the safety and efficacy by short-term following up of choroidal neovascularization(CNV)in high myopia treated with intravitreal Conbercept.

METHODS: Totally 19 eyes from 19 high myopia patients with CNV were reviewed after intravitreal Conbercept therapy. They were all diagnosed in the Ophthalmology Department of our hospital between April 2016 and February 2018. They were between 35 to 73 years old and the average age was 55.40±11.75 years old, 8 male and 11 female. The spherical equivalent refractive error of the 19 eyes was ranged from -19.00D to -7.50D whose mean value was -12.70D±3.23D. All these patients received intravitreal conbercept 0.5mg/0.05mL once per month for 3mo. The clinical features like age, gender, systemic disease, best corrected visual acuity(BCVA)and intraocular pressure(IOP), exudation of CNV by fundus fluorescein angiography(FFA)and central macular thickness(CMT)by optical coherence tomography(OCT)were evaluated before the treatment. The BCVA and IOP were observed after 1d, 1wk, 1mo of each treatment, and the CMT was recorded by OCT after 1wk, 1mo of each treatment, also the variety of CNV that present in FFA was observed after 1mo of the last treatment. These data was compared to the basal data that before intravitreal injection of conbercept to evaluate the clinical efficacy, and the adverse drug reaction was noticed as well. SPSS was used to analysis the change of parameters after treatment for CNV secondary to high myopia.

RESULTS: The pre-injection mean BCVA(LogMAR)at baseline was 0.98±0.29. At the last follow-up visit, the mean post-injection LogMAR BCVA was 0.64±0.16. CMT improved from 324.9±55.6μm to 248.7±17.7μm. The mean post-injection LogMAR BCVA and CMT after each time treatment were both improved than before treatment(P<0.05). However, the data observed after injection was not improved between each other(P>0.05). In these 19 patients, elevated IOP did not occur, besides individual patients had conjunctival hemorrhage, no other significant ocular or systemic injection complications or drug-related side effects were observed.

CONCLUSION: The outcomes of this small case series suggest intravitreal Conbercept to be a safe and promising treatment method for CNV secondary to high myopia with both visual and anatomic improvements and the effect is obvious at the first time injection.