摘要目的 观察玻璃体腔注射雷珠单抗(IVR)治疗渗出型老年性黄斑变性(AMD)伴浆液性视网膜色素上皮脱离(PED)的临床效果.方法 临床确诊为渗出型AMD伴浆液性PED并行IVR治疗的23例患者23只眼纳入研究.所有患者采用国际标准对数视力表行最佳矫正视力(BCVA)检查,检测结果转换为最小分辨角对数(logMAR)记录;并采用光相干断层扫描(OCT)检查测量PED高度、PED容积及黄斑中心凹视网膜厚度(CFT).患眼平均logMAR BCVA为0.77±0.39,平均PED高度为(357.2±171.9) μm,平均PED容积为(0.741±1.012) mm3,平均CFT为(317.9±73.8)μm.治疗方法为手术室无菌条件下常规玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml(含雷珠单抗0.5 mg),每一个月注射1次,连续注射3次,此后根据随访情况按需注射.以末次治疗后6个月为疗效判定时间点,对比分析治疗前后患眼BCVA、PED高度、PED容积及CFT变化情况.结果 治疗后患眼平均logMAR BCVA为0.61±0.27,较治疗前明显提高,差异有统计学意义(t=2.601,P＜0.05).23只眼中,视力提高17只眼,视力稳定4只眼,视力下降2只眼.治疗后患眼平均PED高度为(247.7±171.7)μm,平均PED容积为(0.337±0.498) mm3,平均CFT为(302.5±89.3) μm.与治疗前比较,治疗后患眼平均PED高度、平均PED容积均明显减小,差异有统计学意义(t=3.192、2.502,P＜0.05);平均CFT有所降低,但差异无统计学意义(t=0.887,P＞0.05).所有患者在随访期内均未发生眼内炎、葡萄膜炎等眼部不良反应.结论 IVR能安全有效地治疗伴有浆液性PED的渗出型AMD,提高患者视力,降低PED高度,减小PED容积.

abstractsObjective To evaluate the effects of intravitreal ranibizumab therapy for serous pigment epithelial detachment (sPED) secondary to exudative age-related macular degeneration(eAMD).Methods Twenty-three eyes from 23 patients of eAMD with sPED were enrolled in this study.The best corrected visual acuity,ocular coherence tomography (OCT),maximum PED height from baseline,volume of PED and central fovea thickness(CFT)were collected monthly for these patients.And the patients were receiced intravitreal injection with ranibizumab of 0.5 mg of three consecutive monthly injections.Results No complications were observed during the study period.After 6 months follow-up,17 eyes improved,4 eyes unchanged and only 2 eye decreased.The best corrected visual acuity was from 0.77 ± 0.39 up to 0.61± 0.27(t=2.601,P＜0.05).It was observed by OCT that the PED height was decreased from (357.2± 171.9) μm (before treatment) to (247.7 ± 171.7) μm (after treatment) (t=3.192,P＜0.05) and the volume of PED was decreased from(0.741 ± 1.012) mm3 to (0.337 ± 0.498) mm3 (t =2.502,P＜0.05).The central foveal thickness was decreased from (317.9 ± 73.8) μm to (302.5 ± 89.3)μm,but the difference were no statistically significantly (t =0.887,P＞ 0.05).Conclusion Ranibizumab may be an effective treatment for improving vision and reducing the degree of PED in eAMD patients.