發(fā)布時間：2018-01-16 18:21

  本文關(guān)鍵詞：玻璃體腔注射康柏西普治療特發(fā)性脈絡膜新生血管的臨床療效觀測　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 康柏西普 脈絡膜新生血管疾病 黃斑中心視網(wǎng)膜厚度

【摘要】：目的:探討玻璃體注射康柏西普(Conbercept)治療特發(fā)性脈絡膜新生血管(Idiopathic choroidal neovascularization,ICNV)的臨床療效及安全性。方法:選取2015年1月至2017年1月于大連醫(yī)科大學附屬第一醫(yī)院眼科就診并診斷為ICNV疾病的患者19例(19只眼)納入研究,男4例,女15例,年齡19～45歲,所有患者均入院行玻璃體腔注入10mg/ml的康柏西普0.05ml(含康柏西普0.5mg)治療。于治療后1w、1mo、3mo、6mo、12mo進行隨訪,行BCVA檢查、雙眼裂隙燈顯微鏡檢查眼前節(jié)、眼壓檢查、散瞳后裂隙燈下聯(lián)合+90D前置鏡查眼底、彩色眼底照相、光學相干斷層成像(Optical coherence tomography,OCT)、熒光素鈉眼底血管造影(Fluorescein fundus angiography,FFA)或吲哚青綠血管造影(Indocyanine green angiography,ICGA)檢查,重復注射以每次治療后有無活動性CNV病灶、病灶擴大或新發(fā)病灶或黃斑水腫為標準。統(tǒng)計分析比較治療期間各時間點的最佳矯正視力(Best corrected visual acuity,BCVA)、OCT測量的黃斑中心凹視網(wǎng)膜厚度(Center retinal thickness,CRT)及以外層視網(wǎng)膜(外界膜至RPE/Bruch膜復合體之間的層次)為準線的CNV病灶橫截面積、眼部及全身不良反應。結(jié)果:確診為ICNV疾病的患者共19例(19只眼)納入研究,其中男4例,占21.1%,女15例,占78.9%,年齡21～45歲,平均(32.42±7.78)歲,玻璃體腔注藥次數(shù)平均(2.58±1.64)次。治療前患眼平均BCVA為(0.91±0.61)logMAR,治療后1、3、6、12個月與治療前比較,患眼平均BCVA均較治療前基線明顯提高,分別為(0.50±0.38,0.51 ±0.36,0.51 ±0.37,0.52±0.35)logMAR,差異均有統(tǒng)計學意義(P=0.003,P=0.005,P=0.005,P=0.008,均為p0.05),治療后 1 周與治療前比較以及治療后時間點兩兩比較BCVA差異均無統(tǒng)計學意義。治療前患眼平均CRT值(308.16±85.89)μm,治療后1周、1月、3月與治療前比較,患眼平均CRT值均較治療前(308.16±85.89)μm降低,分別為(275.11±77.03,250.32±48.59,247.37±50.68)μm,差異有統(tǒng)計學意義(P=0.023,P=0.04,P=0.06,均為p0.05),治療后6月、12月與治療前比較以及治療后時間點兩兩比較CRT差異均無統(tǒng)計學意義。治療前CNV病灶橫截面積為(0.32±0.17)mm2,治療后1周(0.24±0.16)mm2、1 月(0.18±0.11)mm2相較治療前(0.32±0.17)mm2與治療后 1 月(0.18±0.11)mm2相較治療后1周(0.24±0.16)mm2,均有統(tǒng)計學意義(P=0.010,P=0.002,P=0.034均為p0.05),其余各治療時間點CNV病灶橫截面積的兩兩比較差異均無統(tǒng)計學意義。19例ICNV注藥患者中治療后有1例眼壓高患者,1月后眼壓自行下降至正常范圍,6例治療后出現(xiàn)輕度結(jié)膜充血,3天內(nèi)均吸收消失,1例輕度結(jié)膜下出血,4天后自行吸收,隨訪期間均未發(fā)生眼內(nèi)炎、晶體破損、視網(wǎng)膜病變等眼部嚴重局部并發(fā)癥及全身不良反應。結(jié)論:玻璃體腔內(nèi)注射康柏西普治療ICNV療效顯著,短期內(nèi)明顯提高或穩(wěn)定患者視力,降低患眼CRT,減輕CNV病灶滲漏,減輕黃斑水腫。早期治療可減少抗血管內(nèi)皮生長因子藥物的注射次數(shù)。玻璃體腔內(nèi)注射康柏西普安全有效,起效迅速,無與治療相關(guān)的不良反應發(fā)生。
[Abstract]:Objective: To investigate the Compaq SEPR (Conbercept) injection of vitreous body for the treatment of idiopathic choroidal neovascularization (Idiopathic choroidal, neovascularization, ICNV) the clinical efficacy and safety. Methods: from January 2015 to January 2017 in the First Affiliated Hospital of Dalian Medical University eye clinic and diagnosed 19 cases of ICNV patients (19 eyes) were included in the study, 4 were male, 15 cases were female, aged from 19 to 45 years old, all the patients received intravitreal injection of 10mg/ml 0.05ml (including Compaq Compaq SEPR Xipu 0.5mg) treatment. After treatment, 1W, 1Mo, 3Mo, 6Mo, 12mo were examined by BCVA double slit lamp biomicroscopy, intraocular pressure examination, after mydriasis under the slit lamp with +90D lens color fundus photography, fundus examination, optical coherence tomography (Optical coherence tomography, OCT), fluorescein fundus fluorescein angiography (Fluorescein fundus angiography, FFA) Indocyanine green angiography (Indocyanine green angiography, ICGA), with repeated injection after each treatment with active CNV lesions, lesions enlarged or new lesions or macular edema as the standard statistical analysis. The best corrected visual acuity during treatment at each time point (Best corrected visual acuity, BCVA), macular foveal thickness measurement of OCT (Center retinal thickness, CRT) and in the outer retina (between the outside membrane to the RPE/Bruch membrane complex level) CNV lesion cross-sectional alignment area, ocular and systemic adverse reactions. Results: the diagnosis of ICNV disease in patients with a total of 19 cases (19 eyes) were included in the study, including 4 cases of male 21.1%, female 15 cases, accounting for 78.9%, age 21 to 45 years old, the average (32.42 + 7.78) years old, the average number of intravitreal drug injection (2.58 + 1.64). Before treatment eyes mean BCVA (0.91 + 0.61) logMAR, 1,3,6,12 months after treatment and Before treatment, the average eye BCVA were compared with the baseline before treatment significantly improved, respectively (0.50 + 0.38,0.51 + 0.36,0.51 + 0.37,0.52 + 0.35) logMAR, the differences were statistically significant (P=0.003, P=0.005, P=0.005, P=0.008, all P0.05), 1 weeks after treatment compared with before treatment and after treatment 22 time points of comparison BCVA. There were no significant differences before treatment in eyes with average value of CRT (308.16 + 85.89) m, 1 weeks after treatment, January, March compared with before treatment, the eyes with average CRT values than before treatment (308.16 + 85.89) m decreased, respectively (275.11 + 77.03250.32 + 48.59247.37 + 50.68) m, the difference was statistically significant (P=0.023, P=0.04, P=0.06, all P0.05), in June December after treatment, compared with before treatment and after treatment of the 22 time points of CRT. There were no significant differences before treatment of CNV lesions in cross-sectional area for (0.32 + 0.17) mm2, after 1 weeks of treatment (0.24. 0.16) mm2,1 June (0.18 + 0.11) mm2 compared with before treatment (0.32 + 0.17) after the treatment with mm2 in January (0.18 + 0.11) mm2 in 1 weeks after the treatment (0.24 + 0.16) mm2, were statistically significant (P=0.010, P=0.002, P=0.034 are P0.05), the rest of the treatment time point CNV lesion cross-sectional area of 22 there were no significant differences in.19 cases of ICNV injection in patients after treatment with 1 cases of patients with high intraocular pressure, intraocular pressure after January to drop to the normal range, mild conjunctival hyperemia occurred in 6 patients after treatment, 3 days were absorbed disappeared, 1 cases of mild subconjunctival hemorrhage, 4 days after self absorption, follow-up period were not endophthalmitis, crystal damage, retinopathy and other eye complications of severe local and systemic adverse reactions. Conclusion: the efficacy of intravitreal injection of etanercept treatment of Compaq ICNV significantly in the short term, improved or stable visual acuity, reduce the risk of eye CRT, reduce CNV leakage, reduce macular edema early. Treatment can reduce the number of injections of anti VEGF drugs. Intravitreal injection of Compaq is safe and effective, with rapid onset and no treatment-related adverse reactions.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R773.4
，

本文編號：1434272