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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2017, Vol. 07 ›› Issue (02) : 49 -59. doi: 10.3877/cma.j.issn.2095-2007.2017.02.001

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抗血管内皮生长因子疗法在眼科中的应用
齐慧君1,†()   
  1. 1. 100044　北京大学人民医院眼科中心
  • 收稿日期:2017-03-08 出版日期:2017-04-28
  • 通信作者: 齐慧君

The Application of anti-vascular endothelial growth factor therapy in ophthalmology

Huijun Qi1,†()   

  1. 1. Department of Ophthalmology, People′s Hospital, Peking University, Beijing 100044, China
  • Received:2017-03-08 Published:2017-04-28
  • Corresponding author: Huijun Qi
  • About author:
    Corresponding author: Qi Huijun, Email:
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引用本文：

齐慧君. 抗血管内皮生长因子疗法在眼科中的应用[J]. 中华眼科医学杂志(电子版), 2017, 07(02): 49-59.

Huijun Qi. The Application of anti-vascular endothelial growth factor therapy in ophthalmology[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2017, 07(02): 49-59.

到目前为止，抗血管内皮生长因子(anti－VEGF)药物正式上市并应用于临床的时间已超过10年。在此期间，anti－VEGF药物依赖其切实可靠的临床疗效，得到了眼科业内广泛的认可，并对眼科及其他相关医疗行业的发展起到了巨大的推动作用。本文中笔者在回顾眼科anti－VEGF药物发展历程的基础上，对anti－VEGF药物在各种眼科疾病中的临床应用情况进行了系统的总结，并以实际的病例报告图片来具体展示anti－VEGF药物的临床疗效。

关键词: 抗血管内皮生长因子, 眼科, 应用

It has been more than ten years since anti-vascular endothelial growth factor drugs (anti-VEGF) were officially listed and used in clinic, up to now. During these years, the effects of anti-VEGF drugs have been recognized by eye care professionals, and these drugs have propelled the development of ophthalmology and the related health care industry. This article reviews the development course of anti-VEGF drugs, and anti-VEGF drugs for the treatment of various diseases of the eye are summarized, and the actual cases picture to show the efficacy of anti-VEGF drugs.

Key words: Anti-vascular endothelial growth factor, Ophthalmology, Application
图1 患者，男性，79岁。诊断为左眼湿性年龄相关性黄斑变性。该患者治疗前与行5次抗血管内皮生长因子治疗后24个月的彩色眼底图像、荧光素眼底血管造影图像、晚期荧光素眼底血管造影图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像　A图、B　图、C图、D　图及E图分别表示该患者治疗前的彩色眼底图像、早期荧光素眼底血管造影图像、晚期荧光素眼底血管造影图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像。A图可见典型性的脉络膜新生血管。C图可见眼底出现明显的渗漏。E图可见神经上皮下产生高密度的脉络膜新生血管和视网膜下液。F图、G　图、H图、I　图及J图分别表示该患者左眼在行5次抗血管内皮生长因子治疗24个月后的彩色眼底图像、早期荧光素眼底血管造影图像、晚期荧光素眼底血管造影图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像。G图、H　图、I图及J图均可见该患者的眼底渗漏消失。H图只可见瘢痕处的染色。J图可见脉络膜新生血管呈扁平瘢痕化，视网膜下液消失
图2 患者，男性，60岁。左眼视力下降1周诊断为息肉状脉络膜血管病变。该患者治疗前与行3次抗血管内皮生长因子治疗后24个月的彩色眼底图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像A图、B　图及C图分别表示该患者治疗前的彩色眼底图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像。A图可见黄斑区出血。B图可见息肉病灶。C图可见视网膜下液。D图、E　图及F图分别表示该患者在行3次抗血管内皮生长因子治疗24个月后的彩色眼底图像、吲哚青绿眼底血管造影图像及光学相干断层扫描图像。D图可见黄斑区出血完全吸收。E图可见息肉消退。F图可见视网膜下液消失
图3 患者，女性，24岁。左眼视力下降2个月，有10年糖尿病史且左眼患有高危增殖性糖尿病性视网膜病变合并糖尿病性黄斑水肿。该患者治疗前与行5次抗血管内皮生长因子联合全视网膜光凝术治疗后的彩色眼底图像和光学相干断层扫描图像　A图和B图分别表示该患者治疗前的彩色眼底图像和光学相干断层扫描图像。A图可见视网膜上出现较多的硬渗性出血和视网膜前出血。B图可见黄斑弥漫性水肿合并囊样水肿。C图和D图分别表示该患者在行5次抗血管内皮生长因子联合全视网膜光凝术治疗后的彩色眼底图像和光学相干断层扫描图像。C图可见视网膜上的硬渗性出血和视网膜前出血完全吸收及大量且规则的激光斑。D图可见黄斑水肿消失
图4 患者，男性，35岁。左眼视力下降1周的左眼上半侧视网膜静脉阻塞合并黄斑水肿。该患者治疗前与行3次抗血管内皮生长因子治疗后的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像　A图、B　图及C图分别表示该患者治疗前的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。A图可见视网膜上半侧静脉迂曲扩张，并可见火焰状及片状出血。B图可见血管壁着染。C图可见黄斑水肿。D图、E　图及F图分别表示该患者在行3次抗血管内皮生长因子治疗后的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。各图像均可见眼底出血渗出完全吸收、静脉的迂曲扩张明显好转、管壁的染色消失且黄斑水肿完全消失
图5 患者，女性，23岁。左眼视力下降2周且诊断为左眼特发性脉络膜新生血管。该患者治疗前与行2次抗血管内皮生长因子治疗后随访24个月的的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像　A图、B　图及C图分别表示该患者治疗前的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。A图可见黄斑少量出血及1个椭圆形灰白色隆起。B图可见脉络膜新生血管的完整轮廓，并伴有明显渗漏。C图可见神经上皮下高密度的脉络膜新生血管、黄斑水肿及视网膜下液。D图、E　图及F图分别表示该患者在行2次抗血管内皮生长因子治疗后的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。D图可见黄斑出血吸收，灰白病灶变小。E图可见脉络膜新生血管缩小并瘢痕化，渗漏消失，瘢痕染色。F图可见视网膜下液吸收，高密度脉络膜新生血管变薄、变小
图6 患者，女性，48岁。右眼视力下降，眼前出现黑影10 d，被诊断为由病理性近视引起的脉络膜新生血管。该患者治疗前与行2次抗血管内皮生长因子治疗后的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像　A图、B　图及C图分别表示该患者治疗前的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。A图可见脉络膜萎缩，黄斑少量出血，并可见1个椭圆形黑灰色病灶。B图可见脉络膜新生血管的完整轮廓，并有明显渗漏。C图可见神经上皮下高密度的脉络膜新生血管和少量视网膜下液。D图、E　图及F图分别表示该患者在行2次抗血管内皮生长因子治疗后的彩色眼底图像、晚期荧光素眼底血管造影图像及光学相干断层扫描图像。D图可见黄斑出血吸收。E图可见脉络膜新生血管缩小瘢痕化、渗漏消失及瘢痕染色。F图可见视网膜下液吸收，高密度脉络膜新生血管变薄、变小
图7 患儿，男性，30周＋2 d出生，体重1.1 kg，矫正胎龄37周＋5 d，诊断为早产儿视网膜病变。对其行2次抗血管内皮生长因子治疗1周后的的彩色眼底图像　A图和B图分别表示该患者治疗前和治疗后的彩色眼底图像。A图可见病灶在1区，附加病变明显，并伴出血。B图可见附加病变明显好转，出血部分吸收
图8 患儿，男性，4岁。右眼视力降低1个月，诊断为外层渗出性视网膜病变2B期。该患儿治疗前与行3次抗血管内皮生长因子治疗后的彩色眼底图像和光学相干断层扫描图像　A图和B图分别表示该患者治疗前的彩色眼底图像和光学相干断层扫描图像。A图可见黄斑区大量黄白色渗出。B图可见黄斑囊样水肿。C图和D图分别表示该患者在行3次抗血管内皮生长因子治疗后的彩色眼底图像和光学相干断层扫描图像。C图可见黄斑区渗出明显吸收。D图可见黄斑水肿明显好转
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