摘要
目的探讨息肉状脉络膜血管病变（PCV）合并玻璃体积血的病例行玻璃体切除术联合雷珠单抗注射的疗效。方法收集2013年1月至2014年6月在深圳市眼科医院就诊的玻璃体积血患者，既往或术后经荧光素眼底血管造影及吲哚青绿血管造影确诊为PCV共15例15只眼。所有病例均采用23G全玻璃体切除术，术毕玻璃体腔注射雷珠单抗0．5mg／0．05ml，其中4只眼伴有出血性视网膜脱离行硅油填充，1只眼因视网膜下巨大血肿行视网膜切开彻底冲洗视网膜下积血并填充硅油。观察手术并发症、术后视力、术后再出血情况、中心凹视网膜厚度变化。结果所有病例无手术并发症发生。至随访6—15个月后，15只眼视网膜均复位良好，其中视力提高13只眼，视力不变2只眼，视力未提高的原因为后极部广泛视网膜下出血及黄斑区瘢痕形成。术后再出血2只眼，经保守治疗后吸收。术后1个月平均中心凹视网膜厚度比术后1周明显减少，差异有统计学意义（t=4．628，P=0．001）。结论玻璃体切除术联合雷珠单抗注射治疗PCV合并玻璃体积血可减少术后再出血及中心凹视网膜厚度，改善视力。最终视力预后与病灶所处部位及视网膜下出血范围密切相关。
Objective To investigate the therapeutic effect of intravitreal injection of ranibizumab （IVR） in pars plana vitrectomy （PPV） on eyes with polypoidal choroidal vasculopathy （PCV） and vitreous hemorrhage. Methods From January 2013 to June 2014, 15 eyes of 15 patients with vitreous hemorrhage and diagnosed as PCV by FFA and ICGA were collected. All patients underwent 23G PPV with IVR （0.5mg/0.05ml） at the end of the operation. Silicon oil tamponade was applied on 4 eyes with hemorrhagic retinal detachment. Retinotomy, elimination of the subretinal hematocele and silicone oil tamponade were performed on 1 eye. Surgical complications, visual acuity （VA）, recurrence of vitreous hemorrhage and retinal thickness of the fovea were recorded and analyzed. Resalts No surgical complication was found in any cases. Retinal attachment was achieved in all 15 eyes at the last follow-up visit. VA improvement was observed in 13 eyes, while postoperative VA maintained unchanged in the other 2 eyes. Widespread subretinal hemorrhage and scar formation in the macula accounted for the poor postoperative VA. Recurrence of vitreous hemorrhage after PPV was observed in 2 eyes, which was alleviated after conservative treatment. The average retinal thickness of the fovea was significantly decreased in 1 month after treatment, week after surgery （t =4.628, P =0.001）. Conclusions The combination crease the possibility of recurrent bleeding and the retinal thickness of the ment of the postoperative VA. Ultimate VA outcome is closely related to comparing with that in 1 of IVR and PPV can defovea, leading to improve- the location of the lesion and the range of subretinal hemorrhage.
出处
《中国实用眼科杂志》
2015年第8期913-917,共5页
Chinese Journal of Practical Ophthalmology
关键词
脉络膜病变
玻璃体切除术
单克隆
抗体
Choroid diseases/therapy
Vitrectomy
Antibodies
Monoclonal
