摘要目的 应用光动力疗法(PDT)联合玻璃体腔注射Bevacizumab治疗息肉状脉络膜血管病变(PCV),探讨治疗前后患者多焦视网膜电图(mfERG)的变化.方法 前瞻性研究.共纳入黄斑型PCV患者13例(13眼),男8例,女5例,年龄(60.2±7.7)岁.所有患者接受吲哚菁绿眼底血管造影(ICGA)指导下6 mg/m2剂量光敏剂Verteporfin的PDT治疗83 s,3 d后行玻璃体腔注射Bevacizumab 1.5 mg(0.06 ml).治疗前及治疗后1、3、6个月,记录视力、眼底荧光素血管造影(FFA)、mfERG各环的潜伏期和振幅密度变化及并发症情况.采用Friedman's检验观察视功能指标的变化情况,当检验发现显著性改变时,采用Wilcoxon检验以比较治疗前后视功能的改变.结果 仅一例患者因为FFA的持续渗漏而于治疗后3个月随访时接受了再次治疗.治疗后平均logMAR视力逐渐提高,治疗后3个月及6个月视力与治疗前比较,差异有统计学意义(Z=-2.823,P=0.005;Z=-2.620,P=0.009).与治疗前相比,6个环的潜伏期无明显下降.治疗后3个月,1环P1波(Z=-2.271,P=0.023)及2环的N1、P1波(Z=-2.202,P=0.028;Z=-1.992,P=0.046)振幅密度明显升高.治疗后6个月,1环P1波(Z=-2.432,P=0.015)及2环的N1、P1波Z=-2.158,P=0.031;Z=-2.118,P=0.034)振幅密度的升高仍具有统计学意义.结论 PDT联合玻璃体腔注射Bevacizumab治疗PCV后病灶血管渗漏改善,视力提高,外层视网膜功能部分恢复.mfERG可以作为一种评价联合治疗后PCV患者视功能变化情况的良好指标.

abstractsObjective To investigate the changes in multifocal electroretinography (mfERG)following combined intravitreal Bevacizumab and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) patients. Methods Prospective study. Thirteen eyes of 13 patients (8 men and 5 women) were recruited for the study. Patients ranged in age from 46 to 71 (60.2±7.7)years.Indocyanine green angiography (ICGA) guided PDT with Verteporfin (6 mg/m2) and was performed according to the recommended standard procedure. Bevacizumab (1.5 mg, 0.06 ml) was injected into the vitreous cavity 3 days later. Visual acuity, fluorescein angiography (FFA) and latencies and average response densities in all 6 rings of mfERG were recorded and compared before treatment and 1, 3 and 6 months after treatment. Results Only one patient needed re-treatment at the 3-month follow-up visit because of persistent leakage on FFA. The mean logMAR visual acuity increased gradually after treatment, and significant increases were observed 3 and 6 months after treatment compared with pre-treatment (Z=-2.823, P=0.005; Z=-2.620, P=0.009). The changes in latencies of the N1 and P1 waves in all 6 rings were not statistically significant. A significant increase in average response densities of both P1 in ring 1 (Z=-2.271, P=0.023) and N1, P1 in ring 2 (Z=-2.202,P=0.028; Z=-1.922, P=0.046) were noted at 3 months post-treatment. The increase in P1 amplitude densities in ring 1(P=0.015) and N1, P1 amplitude densities in ring 2 (Z=-2.158, P=0.031;Z=-2.118, P=0.034) were also significant at 6 months post-treatment. Conclusion Combined intravitreal Bevacizumab and PDT can decrease vessel leakage, improve visual acuity and outer retinal function. mfERG is a good index to evaluate the change in visual function.