本文選題：濕性年齡相關(guān)性黃斑變性 + 血管內(nèi)皮生長因子��； 參考：《山東大學(xué)》2016年碩士論文

【摘要】：背景和目的年齡相關(guān)性黃斑變性(AMD)是致盲的重要疾病,其發(fā)生機制尚不明確,通過修正吸煙這一重要環(huán)境危險因素及補充抗氧化劑可能干預(yù)年齡相關(guān)性黃斑變性的發(fā)生發(fā)展。濕性年齡相關(guān)性黃斑變性(wAMD)的特點為促血管生長因子與抑制血管生長因子之間的作用失衡,導(dǎo)致血管內(nèi)皮生長因子(VEGF)高表達(dá),形成脈絡(luò)膜新生血管(CNV),盡管在AMD中所占比例不高,但確是患者視力嚴(yán)重喪失的最重要原因。光動力療法(PDT)可能導(dǎo)致脈絡(luò)膜灌注不足,使受治療部位發(fā)生明顯炎癥反應(yīng)和VEGF表達(dá)的增加,有損害長期視力預(yù)后的風(fēng)險和高復(fù)發(fā)率；抗VEGF藥物療效顯著,但頻繁注射需承擔(dān)較大手術(shù)風(fēng)險,且受患者經(jīng)濟水平等因素限制�？筕EGF藥物聯(lián)合PDT治療在改善視力的同時可能減少患者再治療次數(shù),本文回顧分析了雷珠單抗聯(lián)合光動力治療隨訪方案治療wAMD的長期有效性和安全性。方法臨床回顧分析了共11例11只眼,每位患者初始行玻璃體腔注射雷珠單抗(IVR) 0.5 mg后7天內(nèi)聯(lián)合標(biāo)準(zhǔn)的PDT療法,此后根據(jù)患者復(fù)診情況繼續(xù)行每月IVR再治療或者觀察。IVR再治療的標(biāo)準(zhǔn)為：1、黃斑區(qū)視網(wǎng)膜厚度增加100μm以上、視網(wǎng)膜下液體、視網(wǎng)膜水腫；2、出現(xiàn)新的視網(wǎng)膜出血或短期內(nèi)視力下降5個字母時行FA檢查有活動性CNV者。前3個月每月隨訪一次,之后每6個月隨訪一次,如果自我監(jiān)測結(jié)果提示異常及時門診復(fù)診。自我監(jiān)測手段包括：視力和Amsler方格表檢查；隨診內(nèi)容包括：包括遠(yuǎn)距離最佳矯正視力(BCVA)、眼壓(1OP)、裂隙燈眼前節(jié)檢查、散瞳后的裂隙燈下眼底檢查及光學(xué)相干斷層掃描(OCT),必要時復(fù)查FA,吲哚菁綠脈絡(luò)膜血管造影(ICGA)在聯(lián)合治療前及隨訪期間排除可疑PCV時進(jìn)行。本研究主要統(tǒng)計分析的數(shù)據(jù)包括：BCVA.IOP.中心視網(wǎng)膜厚度(CRT)及IVR再治療次數(shù)。結(jié)果結(jié)果顯示在為期18個月的隨訪中平均IVR再治療次數(shù)為1.55次(0～8次)；在隨訪的第1、2、3、6、12及18個月相對基線的CRT平均變化值分別為：-136.09±100.61μm、-147.00±110.42μm、-134.91±96.70μm、-145.09±88.51μm、-123.05±118.61μm和-144.82±86.34μm,顯示在聯(lián)合治療后1個月內(nèi)的明顯下降及在隨后保持大致穩(wěn)定趨勢�；颊咧委熐盎�小數(shù)視力范圍為0.02～0.8,轉(zhuǎn)換后的平均平均logMAR見力為0.85±0.56,對應(yīng)的平均小數(shù)視力為0.1-0.15；聯(lián)合治療18個月后,患者的平均logMAR視力為0.72±0.51,較基線值平均提高了相當(dāng)于ETDRS視力表的7.31±15.00個字母。甚至有部分患者在接受治療后維持相對良好的視力超過30個月。隨訪期間沒有與治療相關(guān)的嚴(yán)重并發(fā)癥發(fā)生。結(jié)論雷珠單抗聯(lián)合光動力療法具有降低wAMD臨床干預(yù)次數(shù)并延長療效的作用,可作為患者治療選擇。
[Abstract]:Background and objective AMDD is an important cause of blindness. The mechanism of AMDs is not clear. It may interfere with the occurrence and development of age-related macular degeneration by modifying smoking as an important environmental risk factor and supplementing antioxidants.Wet age-related macular degeneration (WMD) is characterized by the imbalance between promoting and inhibiting vascular growth factor, which leads to the high expression of vascular endothelial growth factor (VEGF) and the formation of choroidal neovascularization (CNV), although the proportion in AMD is not high.But it is the most important cause of severe loss of vision.Photodynamic therapy (PDT) may lead to insufficient choroidal perfusion and increase the expression of VEGF and inflammatory reaction in the treated site, which has the risk of damaging long-term visual prognosis and high recurrence rate.But the frequent injection needs to bear the bigger operation risk, and is limited by the patient's economic level and so on.Anti- VEGF combined with PDT may reduce the number of retreatments while improving visual acuity. The long-term efficacy and safety of combined photodynamic therapy with Lei Zhu McAb in the treatment of wAMD were retrospectively analyzed.Methods 11 patients (11 eyes) were treated with PDT within 7 days after vitreous intravitreal injection of Tetrazumab (0.5 mg).After that, according to the patient's follow-up, the standard of monthly IVR retreatment or observation. IVR retreatment was 1: 1, the retinal thickness of macular area increased more than 100 渭 m, and subretinal fluid.Retinal edema 2, new retinal hemorrhage or short-term visual acuity decline in 5 letters of FA examination of active CNV.The first 3 months were followed up once a month, and then every 6 months.Self-monitoring methods included: visual acuity and Amsler checkup; follow-up included: BCVA, IOP, slit-lamp anterior segment examination.The fundus examination under slit lamp and optical coherence tomography (Oct) were performed after mydriasis. If necessary, FAA and indocyanine green choroidal angiography (ICGA) were performed before combined treatment and during follow-up.The main statistical data of this study include: BCVA.IOP.Central retinal thickness (CRT) and IVR retreatment times.There was a marked decline and then a general stable trend.Before treatment, the range of visual acuity at baseline was 0. 02 鹵0. 8, the mean logMAR after conversion was 0. 85 鹵0. 56, the corresponding mean visual acuity was 0. 1-0. 15. After 18 months of combined therapy, the mean visual acuity was 0. 1-0. 15.The average logMAR visual acuity of the patients was 0.72 鹵0.51, which was equivalent to 7.31 鹵15.00 letters of the ETDRS visual acuity table.Some patients even maintained relatively good vision for more than 30 months after treatment.No severe treatment-related complications occurred during the follow-up period.Conclusion Leizhu McAb combined with photodynamic therapy can reduce the times of clinical intervention and prolong the curative effect of wAMD, so it can be used as the treatment choice for patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R774.5

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