本文選題：超廣角眼底熒光血管造影　切入點(diǎn)：視網(wǎng)膜中央靜脈阻塞　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探索超廣角眼底熒光血管造影(ultra-wide field fluorescein angiography,UWFFA)引導(dǎo)下包括周邊視網(wǎng)膜無(wú)灌注區(qū)在內(nèi)的充分全視網(wǎng)膜光凝(panretinal photocoagulation,PRP)對(duì)缺血型視網(wǎng)膜中央靜脈阻塞(ischemic central retinal vein occlusion,I-CRVO)患者前房血管內(nèi)皮生長(zhǎng)因子(vascular endothalium growth factor,VEGF)濃度及預(yù)后的影響,以期為臨床上治療方案的選擇提供指導(dǎo)。方法:納入缺血型CRVO 30例患者,30只眼,隨機(jī)分為充分PRP組與傳統(tǒng)PRP組,每組15例患者,15只眼。充分PRP組給予抗VEGF治療及包括周邊視網(wǎng)膜在內(nèi)的PRP,傳統(tǒng)PRP組給予抗VEGF治療及不包括周邊視網(wǎng)膜在內(nèi)的PRP。觀察兩組患者的前房VEGF濃度、視網(wǎng)膜無(wú)灌注區(qū)面積(non-perfusion area,NPA)與視盤(pán)面積(disc area,DA)的比值、黃斑中心凹厚度(central macular thickness,CMT)、最佳矯正視力(best corrected visual acuity,BCVA)及注藥次數(shù),并分析上述指標(biāo)隨時(shí)間的變化情況,兩組之間的對(duì)比情況,及指標(biāo)之間的相關(guān)性。結(jié)果:1入組患者在第一、二、三次玻璃體腔注藥前等不同時(shí)間點(diǎn)之間的前房VEGF濃度、CMT、BCVA均有統(tǒng)計(jì)學(xué)差異(F=194.60,P0.00001;F=195.49,P0.00001;F=50.40,P0.00001);視網(wǎng)膜激光光凝治療前后的NPA/DA有統(tǒng)計(jì)學(xué)差異(t=7.211,P0.00001;t=6.77,P0.00001)。2第一次玻璃體腔注藥前,充分PRP組與傳統(tǒng)PRP組相比,患者前房VEGF濃度、CMT、BCVA均無(wú)統(tǒng)計(jì)學(xué)差異(t=0.37,P=0.71;t=-0.39,P=0.69;t=-0.15,P=0.88);第二次玻璃體腔注藥前,充分PRP組與傳統(tǒng)PRP組的前房VEGF濃度、CMT均有統(tǒng)計(jì)學(xué)差異(t=-25.30,P0.00001;t=-4.87,P=0.00006),BCVA無(wú)統(tǒng)計(jì)學(xué)差異(t=-1.83,P=0.08);第三次玻璃體腔注藥前,充分PRP組與傳統(tǒng)PRP組的前房VEGF有統(tǒng)計(jì)學(xué)差異(t=-8.17,p0.00001),cmt、bcva無(wú)統(tǒng)計(jì)學(xué)差異(t=-0.70,p=0.49;t=-1.21,p=0.24)。視網(wǎng)膜激光光凝治療前,充分prp組與傳統(tǒng)prp組npa/da無(wú)統(tǒng)計(jì)學(xué)差異(t=0.19,p=0.85);視網(wǎng)膜激光光凝治療后,充分prp組與傳統(tǒng)prp組npa/da有統(tǒng)計(jì)學(xué)差異(t=-5.14,p=0.00009)。3充分prp組中,第一、二次玻璃體腔注藥前npa/da與vegf均存在直線相關(guān)關(guān)系(r=0.87,p=0.00002;r=0.62,p=0.02),第一、二次玻璃體腔注藥前vegf與cmt均存在直線相關(guān)關(guān)系(r=0.83,p=0.0001;r=0.67,p=0.006),第一次玻璃體腔注藥前vegf與bcva、npa/da與cmt、npa/da與bcva均存在直線相關(guān)關(guān)系(r=0.80,p=0.0004;r=0.84,p=0.0001;r=0.77,p=0.001)。傳統(tǒng)prp組中,第一、二、三次玻璃體腔注藥前npa/da與vegf均存在直線相關(guān)關(guān)系(r=0.93,p=0.000001;r=0.67,p=0.006,;r=0.55,p=0.04),第一、二、三次玻璃體腔注藥前vegf與cmt均存在直線相關(guān)關(guān)系(r=0.82,p=0.0002;r=0.62,p=0.01,;r=0.61,p=0.02),第一、三次玻璃體腔注藥前vegf與bcva均存在直線相關(guān)關(guān)系(r=0.66,p=0.008;r=0.60,p=0.02),第一、二次玻璃體腔注藥前npa/da與cmt均存在直線相關(guān)關(guān)系(r=0.75,p=0.001;r=0.76,p=0.001),第一、二次玻璃體腔注藥前npa/da與bcva均存在直線相關(guān)關(guān)系(r=0.58,p=0.02;r=0.78,p=0.001)。4充分prp組與傳統(tǒng)prp組平均注藥次數(shù)分別為3(3,4)和4(3,5),兩組之間存在統(tǒng)計(jì)學(xué)差異(z=-2.035,p=0.04),充分prp組玻璃體腔注藥次數(shù)少于傳統(tǒng)prp組。結(jié)論:1對(duì)于缺血型crvo患者,抗vegf藥物與激光聯(lián)合應(yīng)用能夠快速降低眼內(nèi)vegf濃度,改善視網(wǎng)膜缺血狀態(tài),減輕黃斑水腫,提高視力。2傳統(tǒng)prp對(duì)于周邊視網(wǎng)膜無(wú)灌注區(qū)激光光凝的缺失是黃斑水腫反復(fù)發(fā)作的重要原因。3uwffa引導(dǎo)下包括周邊視網(wǎng)膜在內(nèi)的充分prp能夠更加有效地改善視網(wǎng)膜缺血狀態(tài)、減輕黃斑水腫、減少?gòu)?fù)發(fā)次數(shù)、減輕治療負(fù)擔(dān),但短期內(nèi)提高視力的作用尚不明確。
[Abstract]:Objective: To explore the ultra wide-angle fundus fluorescein angiography (ultra-wide field fluorescein angiography, UWFFA) full panretinal photocoagulation including peripheral retinal non perfusion area, under the guidance of (panretinal photocoagulation, PRP) for ischemic central retinal vein occlusion (ischemic central retinal vein occlusion, I-CRVO) of vascular endothelial growth factor in patients with anterior chamber (vascular endothalium growth factor VEGF), effect of concentration and prognosis, in order for the clinical treatment of choice to provide guidance. Methods: a total of 30 cases of ischemic CRVO patients, 30 eyes were randomly divided into PRP group and traditional full PRP group, each group of 15 patients, 15 eyes. The full PRP group received anti VEGF therapy and including the surrounding the retina, PRP, traditional PRP group received anti VEGF therapy and does not include peripheral retinal, PRP. observation before the real concentration of VEGF of the two groups of patients, no retinal Perfusion area (non-perfusion area, NPA (disc) and optic disc area, DA) the ratio of foveal thickness (central macular, thickness, CMT), best corrected visual acuity (best corrected visual acuity, BCVA) and the number of drug injection, and analysis of changes in these indicators over time, the comparison between the two groups the correlation and between the indexes. Results: 1 patients in first, second, anterior chamber VEGF concentration between the three intravitreous injection before the different time point of CMT, BCVA were statistically difference (F=194.60, P0.00001; F= P0.00001; 195.49, F=50.40, P0.00001); before and after laser photocoagulation on NPA/DA statistical difference (t=7.211, P0.00001; t=6.77, P0.00001).2 first intravitreous injection before the full PRP group compared with the traditional PRP group, anterior chamber VEGF concentration in patients with CMT, there was no significant difference in BCVA (t=0.37, P=0.71; t=-0.39, P=0.69; t=-0.15, P=0.88) Second; intravitreous injection, anterior chamber concentration of VEGF full PRP group and traditional group PRP, CMT were statistically significant (t=-25.30, P0.00001; t=-4.87, P=0.00006), there was no significant difference in BCVA (t=-1.83, P=0.08); third intravitreous injection, full PRP group and traditional group PRP anterior chamber VEGF statistical difference (t=-8.17, p0.00001, CMT), there was no significant difference in BCVA (t=-0.70, p=0.49; t=-1.21, p=0.24). The retinal laser photocoagulation before treatment, no significant difference between the npa/da group and the traditional full PrP group PrP (t=0.19, p=0.85); visual laser net membrane coagulation treatment, there is significant difference in PRP group and fully the traditional PrP npa/da group (t=-5.14, p=0.00009).3 in the PrP group, there were linear correlation between the first, second intravitreous injection of npa/da and VEGF (r=0.87, p=0.00002; r=0.62, p=0.02), there were linear correlation between the first, second intravitreous injection of VEGF and CMT (r=0.83, P=0.0001; r=0.67, p=0.006), the first intravitreous injection of VEGF and BCVA, npa/da and CMT, there was linear correlation between npa/da and BCVA (r=0.80, p=0.0004; r=0.84, p=0.0001; r=0.77, p=0.001). The traditional first, second PrP group, and there were linear correlation between the three intravitreous injection before npa/da with VEGF (r=0.93, p=0.000001; r=0.67, p=0.006; r=0.55, p=0.04), first, second, there were linear correlation between the three intravitreous injection of VEGF and CMT (r=0.82, p=0.0002; r=0.62, p=0.01; r=0.61, p=0.02), there were linear correlation between the first, third intravitreous injection of VEGF and BCVA (r=0.66, p=0.008; r=0.60, p=0.02), there were linear correlation between the first, second intravitreous injection of npa/da and CMT (r=0.75, p=0.001; r=0.76, p=0.001), there were linear correlation between the first, second intravitreous injection of npa/da and BCVA (r=0.58, p=0.02; r=0.78, p=0.001).4 The full PrP group and traditional group PrP average injection times were 3 (3,4) and 4 (3,5), there was significant difference between the two groups (z=-2.035, p=0.04), the full group PrP intravitreal injection is less than the traditional PrP group. Conclusion: 1 for patients with ischemic CRVO, anti VEGF drugs combined with laser application can rapidly reduce the intraocular concentration of VEGF, improve the state of retinal ischemia, alleviate macular edema and improve visual acuity loss.2 PRP for the traditional peripheral retinal non perfusion laser photocoagulation is fully PrP including peripheral retina,.3uwffa an important cause of recurrent macular edema under the guidance can effectively improve the ischemic state and macular edema., reduced relapse frequency, reduce the burden of treatment, but in the short term to improve the visual effect is not clear.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.63

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