發(fā)布時(shí)間：2018-05-24 15:51

  本文選題：Bevacizumab + 眼底新生血管�。� 參考：《昆明醫(yī)學(xué)院》2010年碩士論文

【摘要】： 目的:研究玻璃體腔注射bevacizumab治療眼底新生血管術(shù)后對黃斑功能的影響,評價(jià)其眼內(nèi)用藥安全性。 方法:利用Humphrey750型計(jì)算機(jī)自動視野計(jì),分別于2008年9月至2010年2月在我院接受bevacizumab玻璃體腔注射術(shù)(每月一次,連續(xù)兩月)的43例(48只眼)眼底新生血管患者行術(shù)前、術(shù)后一月、術(shù)后六月SITA快速10-2及黃斑中心凹閾值檢測程序檢查。檢查結(jié)果按鼻上、鼻下、顳上和顳下四個(gè)象限分別將各個(gè)象限中的每一個(gè)位點(diǎn)進(jìn)行編號,比較特定選擇區(qū)域內(nèi)(如圖1示)視網(wǎng)膜光敏感度(mean sensitivity,MS),平均缺損度(mean defect,MD)、模式標(biāo)準(zhǔn)差(pattern standard deviation,PSD),黃斑閾值(Fovea)以及中心暗點(diǎn)(central scotoma)的變化。應(yīng)用光學(xué)相關(guān)斷層掃描儀觀察黃斑區(qū)視網(wǎng)膜形態(tài),并對黃斑區(qū)視網(wǎng)膜神經(jīng)上皮層厚度進(jìn)行測量,比較術(shù)前術(shù)后的解剖及功能變化。 結(jié)果:1.“點(diǎn)對點(diǎn)”比較選擇區(qū)域內(nèi)的20個(gè)位點(diǎn),發(fā)現(xiàn)18個(gè)位點(diǎn)術(shù)前術(shù)后的變化無統(tǒng)計(jì)學(xué)意義(p＞0.05),2個(gè)位點(diǎn)分貝數(shù)的提高具有統(tǒng)計(jì)學(xué)意義(P＜0.05);2.平均缺損度(MD)由術(shù)前-10.12±6.52降低至術(shù)后一月-7.91±5.49及術(shù)后六月-7.06±4.72,具有統(tǒng)計(jì)學(xué)意義(P＜0.05);3.模式標(biāo)準(zhǔn)差(PSD)由術(shù)前4.69±3.10降低至術(shù)后一月4.44±2.83及術(shù)后六月4.03±2.89,差異無顯著性(P＞0.05);4.黃斑中心凹閾值(Fovea)由術(shù)前24.70±5.75提高至術(shù)后一月26.75±5.39及術(shù)后六月27.85±4.52,具有統(tǒng)計(jì)學(xué)意義(P＜0.05);5.視野內(nèi)絕對暗點(diǎn)及相對暗點(diǎn)的數(shù)量從術(shù)前14.85±9.43及23.15±10.01分別減少至術(shù)后一月9.35±7.54及16.25±11.01,術(shù)后六月8.10±8.87及14.56±10.31,差異具有統(tǒng)計(jì)學(xué)意義(p＜0.05)。有三例患者治療后中心暗點(diǎn)擴(kuò)大,至末次隨訪仍高于基線水平;6.最佳矯正視力由術(shù)前0.46±0.16提高至術(shù)后一月0.56±0.19及術(shù)后六月0.61±0.21,有顯著性差異(P＜0.01);7.黃斑中心凹厚度(Foveal Thickness)由術(shù)前303.69±92.13降低至術(shù)后一月278.98±64.80及術(shù)后六月255.64±67.53,具有統(tǒng)計(jì)學(xué)意義,(P＜0.05);8.注藥術(shù)前和術(shù)后六月最佳矯正視力與平均缺損度(MD)、模式標(biāo)準(zhǔn)差(PSD)、黃斑中心凹閾值(Fovea)及黃斑中心凹厚度(Foveal Thickness)間均有相關(guān)性(p＜0.05)。 結(jié)論:1.連續(xù)兩次玻璃體腔注射bevacizumab(2.5mg)治療眼底新生血管術(shù)后中心視網(wǎng)膜光敏感性提高,黃斑功能普遍提高或趨于平穩(wěn)。2.有少數(shù)病例術(shù)后中心暗點(diǎn)擴(kuò)大,平均缺損度(MD)及模式標(biāo)準(zhǔn)差(PSD)數(shù)值提高,表現(xiàn)出視野損傷的進(jìn)展。
[Abstract]:Objective: to study the effect of intravitreal injection of bevacizumab on macular function after fundus neovascularization. Methods: from September 2008 to February 2010, 43 patients (48 eyes) with fundus neovascularization underwent bevacizumab intravitreal injection (once a month for two months) from September 2008 to February 2010. SITA and macular fovea threshold were examined 6 months after operation. The results were numbered according to each of the four quadrants of the nasal, subnasal, supratemporal and infratemporal quadrants. The changes of retinal light sensitivity, mean defectd, pattern standard deviation, macular threshold and central scotoma were compared in selected regions (Fig. 1). The retinal morphology of macular area was observed by optical correlation tomography and the thickness of retinal neuroepithelial layer in macular area was measured to compare the anatomic and functional changes before and after operation. The result is 1: 1. "Point-to-point" comparison of 20 loci in the selected region showed that there was no significant change in 18 loci before and after operation (p > 0.05), and the increase in the number of decibels at 2 loci was statistically significant (P < 0.05). The MDD decreased from 10.12 鹵6.52 before operation to 7.91 鹵5.49 at 1 month after operation and 7.06 鹵4.72 at 6 months after operation, with statistical significance (P < 0.05). The model standard deviation (PSD) decreased from 4.69 鹵3.10 before operation to 4.44 鹵2.83 at one month after operation and 4.03 鹵2.89 at 6 months after operation, with no significant difference (P > 0.05). The fovea of macular fovea increased from 24.70 鹵5.75 before operation to 26.75 鹵5.39 in one month and 27.85 鹵4.52 in 6 months after operation, which was statistically significant (P < 0.05). The number of absolute and relative dark spots in the visual field decreased from 14.85 鹵9.43 and 23.15 鹵10.01 to 9.35 鹵7.54 and 16.25 鹵11.01 in one month after operation, and 8.10 鹵8.87 and 14.56 鹵10.31 in June after operation. The difference was statistically significant (P < 0.05). In three patients, the central dark spot was enlarged after treatment, and at the last follow-up, it was still above the baseline level of 6. 5%. The best corrected visual acuity increased from 0.46 鹵0.16 before operation to 0.56 鹵0.19 at one month after operation and 0.61 鹵0.21 at 6 months after operation (P < 0.01). The thickness of foveal fossa decreased from 303.69 鹵92.13 before operation to 278.98 鹵64.80 in one month and 255.64 鹵67.53 in 6 months after operation, which was statistically significant (P < 0.05). There was a correlation between the best corrected visual acuity before and six months after injection and MDD, PSDD, fovea and foveal thickness (P < 0.05). Conclusion 1. Two consecutive intravitreous injections of bevacizumaban 2.5 mg) improved the sensitivity of central retina after fundus neovascularization, and the macular function generally improved or tended to be stable. 2. In a few cases, the central dark spot was enlarged, and the mean degree of defect (MDM) and model standard deviation (PSDs) were increased, showing the progress of visual field injury.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.1

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本文編號：1929651