本文選題：Avastin　切入點(diǎn)：黃斑水腫　出處：《大連醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的：觀察玻璃體內(nèi)注射Avastin治療黃斑水腫(ME)的療效。 方法：經(jīng)雙目間接檢眼鏡、光學(xué)相干斷層掃描(OCT)或(和)熒光素眼底血管造影(FFA)檢查確診黃斑水腫患者共69例76眼,按病因分為視網(wǎng)膜中央靜脈阻塞(CRVO)、視網(wǎng)膜分支靜脈阻塞(BRVO)及糖尿病性視網(wǎng)膜病變(DR)三組,行玻璃體內(nèi)注射Avastin 1.25mg/0.05ml。隨訪2-13個(gè)月,觀察視力、眼壓、晶狀體、眼底情況,FFA觀察黃斑水腫及毛細(xì)血管滲漏情況,OCT檢查黃斑水腫情況及黃斑中心視網(wǎng)膜厚度(CMT)。 結(jié)果：視力的統(tǒng)計(jì)結(jié)果顯示,三組患者治療前與治療后1w、1m、2m、3m四個(gè)時(shí)間點(diǎn)最佳矯正視力的LogMAR值相比均有顯著性差異,即治療后視力顯著提高。CRVO所致ME患者治療后各時(shí)間點(diǎn)之間LogMAR值無(wú)顯著性差異；BRVO所致ME患者治療后1m與治療后2m、3m的最佳矯正視力LogMAR值相比存在差異,t值分別為-2.282、-3.000,P值分別為0.031、0.006,即治療后1m達(dá)最好視力,治療后2m、3m有所下降；DME患者治療后1 w和治療后1 m最佳矯正視力的LogMAR值分別為0.57±0.32、0.54±0.27,二者之間存在統(tǒng)計(jì)學(xué)差異(P＜0.05),即治療后1m視力優(yōu)于治療后1w視力,而治療后1m、2m、3m三者之間比較無(wú)顯著性差異。CMT的統(tǒng)計(jì)結(jié)果顯示,三組患者治療后1m、2m、3m黃斑中心視網(wǎng)膜厚度均較治療前存在顯著性差異,即黃斑中心視網(wǎng)膜厚度較治療前明顯變薄,黃斑水腫明顯改善。CRVO所致ME患者治療后1m與治療后3m CMT分別為(337.57±35.851)μm、(375.11±23.219)μm,相比較有顯著性差異(P＜0.05)；BRVO所致ME患者和DME患者治療后各時(shí)間點(diǎn)CMT值之間差異無(wú)統(tǒng)計(jì)學(xué)意義。OCT圖像顯示治療后黃斑視網(wǎng)膜厚度明顯變薄。FFA顯示治療后黃斑區(qū)熒光素滲漏明顯減少,即黃斑水腫明顯消退。對(duì)眼壓的統(tǒng)計(jì)結(jié)果顯示,BRVO所致ME患者及DME患者治療前后各時(shí)間點(diǎn)的眼壓之間比較無(wú)統(tǒng)計(jì)學(xué)差異(P＞0.05),CRVO患者治療后1w較治療前眼壓升高,且有統(tǒng)計(jì)學(xué)差異(P＜0.05)。11眼在2個(gè)月復(fù)查時(shí)出現(xiàn)視力再度下降,復(fù)查FFA結(jié)果顯示黃斑區(qū)視網(wǎng)膜水腫復(fù)發(fā),給予玻璃體內(nèi)Avastin同一劑量重復(fù)注射,術(shù)后1個(gè)月視力恢復(fù),黃斑水腫消退。3眼在治療后第1d有角膜上皮的小片狀剝脫,9眼治療后出現(xiàn)注射部位的小片狀結(jié)膜下出血,無(wú)眼壓嚴(yán)重升高、白內(nèi)障、眼內(nèi)炎、視網(wǎng)膜脫離等嚴(yán)重并發(fā)癥發(fā)生。 結(jié)論：玻璃體內(nèi)注射Avastin可有效治療CRVO、BRVO、DR所致的ME,部分患者需重復(fù)注藥以維持療效。本研究中未發(fā)現(xiàn)與藥物有關(guān)的嚴(yán)重的眼部及全身不良反應(yīng)。
[Abstract]:Objective: to observe the effect of intravitreal injection of Avastin on macular edema. Methods: a total of 69 cases (76 eyes) with macular edema were diagnosed by binocular indirect ophthalmoscope, optical coherence tomography (Oct) or / and fluorescein fundus angiography (FFAA). The patients were divided into three groups according to their etiology: central retinal vein occlusion (CRVO), retinal branch vein occlusion (BRVOO) and diabetic retinopathy (Dr). Intravitreous injection of Avastin 1.25 mg / 0.05ml was performed. The visual acuity, intraocular pressure and lens were observed after follow-up for 2-13 months. Macular edema and capillary leakage were observed by FFA. Macular edema and central retinal thickness were examined by Oct. Results: the statistical results of visual acuity showed that the LogMAR values of the best corrected visual acuity (BCVA) in the three groups were significantly different between before treatment and 1 week after treatment. That is, there was no significant difference between the LogMAR values of ME patients after treatment and the LogMAR values of the patients with ME caused by BRVO at 1 m after treatment and 2 mm after treatment respectively. The difference in LogMAR value was -2.282 鹵-3.000g / p, respectively, in the patients with ME caused by the improved visual acuity after treatment and the LogMAR values of the patients with ME caused by BRVO at 2 mm and 2 m after treatment, respectively. The visual acuity was 0.031 鹵0.006, that is, the best visual acuity was 1 m after treatment. The LogMAR values of the best corrected visual acuity (BCVA) were 0.57 鹵0.32 鹵0.54 鹵0.27 at 1 week after treatment and 1 m after treatment, respectively. There was significant difference between the two groups (P < 0.05), that is, the visual acuity of 1 m after treatment was better than that of 1 week after treatment. The statistical results of CMT showed that there was significant difference in retinal thickness of macular center between the three groups after treatment, that is, the retinal thickness of macular center was significantly thinner than that of before treatment, and there was no significant difference among the three groups after treatment, and the results showed that the retinal thickness of macular center in the three groups was significantly thinner than that before treatment, and there was no significant difference in retinal thickness between the three groups after treatment. Macular edema was significantly improved in patients with ME induced by .CRVO and 3m CMT was 337.57 鹵35.851 渭 m after treatment and 375.11 鹵23.219 渭 m after treatment, respectively. There was no significant difference in CMT value between ME patients and DME patients after treatment (P < 0.05). Oct image showed no significant difference. FFA showed that the fluorescein leakage in the macular area was significantly decreased after treatment. The statistical results of intraocular pressure showed that there was no significant difference in intraocular pressure between patients with ME and DME before and after treatment (P > 0.05). The visual acuity of 11 eyes was decreased again after 2 months reexamination. The results of FFA showed that retinal edema recurred in macular area, the same dose of intravitreal Avastin was injected repeatedly, and the visual acuity recovered 1 month after reexamination. Macular edema subsided in 3 eyes on the 1st day after treatment, 9 eyes with corneal epithelium had small flake subconjunctival hemorrhage at the injection site after treatment, no serious elevation of intraocular pressure, cataract, endophthalmitis, retinal detachment and other serious complications occurred. Conclusion: intravitreous injection of Avastin is effective in the treatment of CRV / BRVOD Dr. Some patients need repeated injection to maintain the efficacy. No serious eye and systemic adverse reactions related to drugs were found in this study.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R774.5

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