摘要目的 观察息肉样脉络膜血管病变(PCV)临床个性化治疗方案的效果.方法 临床检查确诊的PCV患者79例86只眼纳入研究.患者中,男性60例65只眼,女性19例21只眼.平均年龄(64.48±13.15)岁.均行最佳矫正视力(BCVA)、裂隙灯显微镜联合前置镜、眼底彩色照相、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)和(或)吲哚青绿血管造影(ICGA)检查.患眼平均BCVA 0.19±0.20.根据息眼所接受治疗情况不同分为单纯光动力疗法(PDT)治疗组(A组)、PDT联合玻璃体腔注射雷珠单抗治疗组(B组)、PDT联合后Tenons囊下注射曲安奈德治疗组(C组),分别为45、31、10只眼.治疗后1个月复查,以后根据临床需要定期复查.A组45只眼中,治疗后失访5只眼,其余治疗眼平均随访时间3.27个月.B组31只眼中,治疗后失访3只眼,其余治疗眼平均随访时间6.68个月.C组10只眼中,治疗后失访1只眼,其余治疗眼平均随访时间5.67个月.随访病情加重或复发者行FFA和(或)ICGA检查.对比分析患眼治疗前与治疗后1个月BCVA、中心凹视网膜厚度的变化;观察治疗后病灶消退、复发或加重的情况.结果 A组45只眼均接受1次治疗;B组31只眼中,接受1次治疗20只眼,占64.5％;C组10只眼中,接受1次治疗9只眼,占90.0％.治疗后1个月A、B、C组患眼BCVA与治疗前比较,差异有统计学意义(t=2.061、3.262、3.258,P＜0.05);3组间治疗后1个月患眼平均BCVA比较,差异无统计学意义(t=1.345、0.683、0.168,P＞0.05).治疗后1个月,A、B组患眼平均中心凹视网膜厚度与治疗前比较,差异有统计学意义(t=2.239、4.334,P＜0.05);C组患眼平均中心凹视网膜厚度与治疗前比较,差异无统计学意义(t=2.286,P＞0.05).FFA和(或)ICGA检查结果显示,A组接受检查的13只跟中,息肉样病灶、色素上皮脱离(PED)消退3只眼;息肉样病灶、PED减少4只眼;息肉样病灶仍然存在3只眼;息肉样病灶伴PED加重3只眼.B组接受检查的10只眼中,息肉样病灶消退3只眼;息肉样病灶减少3只眼;息肉样病灶消退后复发4只眼.C组接受检查的5只眼中,息肉样病灶消退4只眼;息肉样病灶消退后复发1只眼.结论 单纯PDT、PDT联合玻璃体腔注射雷珠单抗或后Tenons囊下注射TA均能不同程度使息肉样病灶消退或渗漏减轻;患眼视力稳定或提高.

abstractsObjective To observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).Methods Eighty-six eyes of 79 patients with PCV were enrolled in this study.There were 60 males (65 eyes) and 19 females (21 eyes).The average age was (64.48±13.15) years old.Best corrected visual acuity (BCVA),slit lamp ophthalmoscopy,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured.The average BCVA was 0.19 ± 0..20.There were three groups in this study including photodynamic therapy (PDT) group (group A,45 eyes),PDT and intravitreal ranibizumab injection group (group B,31 eyes),and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C,10 eyes).Follow up begun at 1 month after the treatment.40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months.9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months.Patients with recurrent or worsen lesions were followed by FFA or ICGA.Pre-and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.Results All eyes (100.0 ％) in group A,20 eyes (64.52％) in group B and 9 eyes (90.00％) in group C received treatment only once.The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061,3.262,3.258; P＜0.05),but no significant difference was found between the 3 groups (t=1.345,0.683,0.168; P＞0.05).Compared to pre-treatment measures,the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239,4.334; P＜0.05),but not changed in group C (t=2.286,P＞0.05) at 1 month after treatment.Thirteen eyes in group A were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED),4 eyes with partial closed PCV,3 eyes with stable PCV and 3 eyes with worsen PCV.Ten eyes in group B were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV,3 eyes with partial closed PCV,4 eyes with recurrence PCV.Five eyes in group C were followed by FFA and (or) ICGA,which showed that there were 4 eyes with complete closed PCV,1 eyes with recurrence PCV.Conclusion All 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.