本文關(guān)鍵詞： 病理性近視 脈絡(luò)膜新生血管 可植入型人工晶體 光動(dòng)力療法 貝伐單抗 聯(lián)合治療　出處：《浙江大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：病理性近視(pathologic myopia, PM),又稱為高度近視、變性性近視,是指屈光度6.0D,眼軸26mm的近視,通常伴有視網(wǎng)膜,脈絡(luò)膜和鞏膜的變性性改變。其眼底改變包括漆裂紋,Fuch's斑,脈絡(luò)膜視網(wǎng)膜萎縮,脈絡(luò)膜新生血管(choroidal neovascularization, CNV)等。其中CNV形成是造成病理性近視視力損害的最重要的原因之一。 治療病理性近視CNV的方法包括激光光凝治療,經(jīng)瞳孔溫?zé)岑煼?transpupillary thermotherapy, TTT),光動(dòng)力學(xué)療法(photodynamic therapy, PDT),手術(shù)及藥物治療等。 病理性近視由于其屈光度數(shù)較高,并不適合行如準(zhǔn)分子激光角膜切削術(shù)(photorefractive keratectomy, PRK),準(zhǔn)分子激光原位角膜磨鑲術(shù)(laser in situ keratomileusis, LASIK)等角膜屈光手術(shù)。目前矯正高度近視較常用的方法是前房或后房型有晶體眼人工晶體(phakic intraocular lenses, PIOLs)植入術(shù)。其中由Staar公司生產(chǎn)的可植入型人工晶體(implantable contact lens, ICL)植入術(shù)為矯正病理性近視提供了較為安全,有效的解決途徑。經(jīng)過此類手術(shù)的病理性近視患者,雖然其屈光狀態(tài)發(fā)生了改變,然而其疾病的性質(zhì)并沒有發(fā)生改變。經(jīng)ICL植入術(shù)后的近視患者仍然會(huì)出現(xiàn)病理性近視眼底改變。截止到目前為止,沒有資料顯示ICL植入術(shù)后與CNV發(fā)病有相關(guān)性,該類患者CNV的治療目前還沒有學(xué)者進(jìn)行討論和研究。 我們隨訪觀察浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院眼科的一名經(jīng)ICL植入術(shù)后發(fā)生CNV的37歲女性患者4年,在經(jīng)過一次PDT及一次PDT聯(lián)合玻璃體腔注射貝伐單抗后,通過觀察該患者最佳矯正視力(best corrected visual acuity, BCVA)的變化,CNV在光學(xué)相干斷層掃描(Optical Coherence Tomography, OCT)中形態(tài)學(xué)變化,CNV在眼底熒光血管造影(fluorescence fundus angiography, FFA)及吲哚青綠血管造影(indocyanine green angiography, ICGA)中的變化情況,進(jìn)行相關(guān)臨床治療療效分析研究。經(jīng)過4年的臨床觀察,該患者左眼在經(jīng)過一次PDT及一次PDT聯(lián)合玻璃體腔注射貝伐單抗聯(lián)合治療后,病情基本上得到了控制。左眼眼底檢查顯示左眼黃斑中心凹下新生血管膜區(qū)變成不活動(dòng)的疤痕。BCVA現(xiàn)一直穩(wěn)定在20/100。ICGA, FFA顯示黃斑中心凹區(qū)滲漏完全消失。OCT檢查顯示該患者黃斑區(qū)CNV完全變平。治療過程中無眼部及全身不良事件發(fā)生。 該例患者的臨床隨訪觀察結(jié)果顯示PDT, PDT聯(lián)合玻璃體腔注射貝伐單抗可考慮作為ICL術(shù)后發(fā)生近視性CNV的治療方法。
[Abstract]:Pathologic myopia, PMX, also known as high myopia, denatured myopia, refers to myopia of 6.0D and 26mm of axis. Often accompanied by degeneration of the retina, choroid and sclera, the fundus changes include lacquer cracks, Fuchus spot, and choroidal retinal atrophy. Choroidal neovascularization. CNV is one of the most important causes of visual impairment in pathological myopia. The methods of treating pathological myopia include laser photocoagulation and transpupillary thermotherapy (TTT). Photodynamic therapy, PDT, surgery and drug therapy. Pathological myopia is not suitable for photorefractive keratectomy (PRK) because of its high diopter. Laser in situ keratomileusis with laser in situ keratomileusis. Corneal refractive surgery such as LASIK.At present, the commonly used methods for correction of high myopia are anterior chamber or posterior chamber type intraocular lens (IOL). Phakic intraocular lenses. The implantable intraocular lens (IOL), produced by Staar, is an implantable contact lens. ICL) implantation provides a safe and effective way to correct pathological myopia. However, the nature of the disease has not changed. Myopia patients after ICL implantation will still have pathological myopia fundus changes. So far. There is no correlation between ICL implantation and the incidence of CNV. The treatment of CNV in this group of patients has not been discussed and studied by scholars. We followed up a 37-year-old female patient who developed CNV after ICL implantation in the first affiliated Hospital of Zhejiang University School of Medicine for 4 years. After one injection of bevacizumab with PDT and one PDT combined with vitreous injection. The best corrected visual acuities (BCVA) were observed. The morphological changes of CNV were observed in optical Coherence tomography (Oct). CNV had fluorescence fundus angiography in fundus fluorescein angiography. FFAA) and indocyanine green angiography (ICGA) on indocyanine green angiography. After 4 years of clinical observation, the patient's left eye was treated with one PDT and one PDT combined with intravitreal injection of bevacizumab. The left eye fundus examination showed that the subcentral foveal neovascularization of the left eye became an inactive scar. BCVA has been stable at 20 / 100.ICGA. FFA showed complete disappearance of macular fovea leakage. Oct showed that the macular area CNV flattened completely. No eye or systemic adverse events occurred during the treatment. The clinical follow-up results showed that PDT, PDT combined with intravitreal injection of bevacizumab could be considered as a treatment for myopic CNV after ICL.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R778.11

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 王海燕;王雨生;胡丹;張鵬;賀竹寧;汪春歸;蘇曉娜;李曼紅;李曉;武炳慧;;光動(dòng)力療法治療國人常見脈絡(luò)膜新生血管疾病的二年隨訪觀察[J];眼科;2010年04期

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