光学相干断层扫描血管成像技术在康柏西普对湿性年龄相关性黄斑变性治疗效果评价中的临床研究

doi:10.3877/cma.j.issn.2095-2007.2021.03.003

目的

利用光学相干断层扫描血管成像技术(OCTA)评估康柏西普治疗湿性年龄相关性黄斑变性(AMD)的疗效。

方法

收集2016年4月至2018年12月在内蒙古民族大学附属医院眼科诊断为湿性AMD的32例(40只眼)患者。其中，男性19例(23只眼)，女性13例(17只眼)；年龄54~83岁，平均年龄(68.0±7.5)岁。采用连续3次每月注射后改用按需的方案进行治疗。记录患者术前、术后1 d、3 d、7 d、1个月、2个月、3个月和6个月的最佳矫正视力(BCVA)、视网膜黄斑厚度(CMT)和脉络膜新生血管(CNV)面积。治疗前与治疗后不同时间点，患者的BCVA、CNV面积及CMT经过正态性检验，符合正态分布，采用均数±标准差进行描述，治疗前后的比较采用单因素重复测量方差分析，当差异有统计学意义时，进一步两两比较。

结果

湿性AMD的32例(40只眼)患者中1型CNV者10例(12只眼)，占31.2%；2型CNV者22例(28只眼)，占68.8%。湿性AMD 1型CNV和2型CNV者治疗后6个月黄斑区水肿渗出均较治疗前减少，荧光素渗漏均减少，黄斑区神经上皮层和视网膜色素上皮层间隆起距离均变小，新生血管有所消退。湿性AMD患眼治疗前BCVA、CNV面积及CMT分别为(0.78±0.46)、(1.56±0.92)mm²、(304.73±121.27)μm；治疗后6个月分别为(0.51±0.35)、(1.18±0.79)mm²、(235.90±62.18)μm。经单因素重复测量方差分析，不同时间点治疗前后BCVA、CNV面积及CMT比较的差异有统计学意义(F＝6.878，6.952，5.365；P<0.05)。进一步比较，经t检验，患者治疗后6个月与治疗前BCVA、CNV面积及CMT比较的差异有统计学意义(t＝4.19，3.96，3.58；P<0.05)。

结论

OCTA可以直观清晰地显示CNV病灶形态，并提供CMT和CNV面积等，能为湿性AMD的抗血管内皮细胞生长因子治疗和愈后评估提供参考。

关键词: 光学相干断层扫描血管成像技术, 湿性年龄相关性黄斑变性, 康柏西普, 脉络膜新生血管, 疗效

Objective

The aim of this study is to evaluate the efficacy of Conbercept in the treatment of wet age-related macular degeneration (AMD) using the optical coherence tomography angiography (OCTA).

Methods

32 patients (40 eyes) diagnosed with wet AMD from the Department of Ophthalmology, Affiliated Hospital of Inner Mongolia University for Nationalities from April 2016 to December 2018 were collected retrospectively. Among of them, there were 19 males (23 eyes) and 13 females (17 eyes); they were 54 to 83 years-old with an average age of (68.0±7.5) years-old. After 3 consecutive monthly injections, they were switched to an on-demand treatment plan for treatment. The patient′s preoperative, 1 day, 3 days, 7 days, 1 month, 2 months, 3 months and 6 months after the operation best corrected visual acuity (BCVA), fluorescein fundus angiography (FFA) leakage, retinal structure integrity, central macular thickness (CMT) and choroidal neovascularization ( CNV) area were recorded. At different time points before and after treatment, BCVA, CNV area, and CMT were tested for normality and conformed to normal distribution. The mean±standard deviation was used for description. The comparison before and after treatment was used single-factor repeated measures analysis of variance. When the difference is statistically significant, further pairwise was comparised.

Results

Among of 32 cases (40 eyes) of wet AMD, there were 10 cases (12 eyes) with type 1 CNV, accounting for 31.2%; 22 cases (28 eyes) with type 2 CNV, accounting for 68.8%. After treatment for 6 months, macular edema, exudation, fluorescein leakage, retinal pigment epithelium protrusion and neocapillaries subsided in wet AMD patients with type 1 CNV and type 2 CNV. The preoperative BCVA, CNV area and CMT of eyes with wet AMD were (0.78±0.46), (1.56±0.92) mm², (304.73±121.27) μm, respectively; after treat-ment for 6 months, the BCVA, CNV area and CMT of eyes with wet AMD were (0.51±0.35), (1.18±0.79) mm², (235.90±62.18) μm, respectively. There were significant differences in BCVA, CNV area and CMT before and after treatment at different time points (F= 6.878, 6.952, 5.365; P<0.05). For further comparison, after t testing, the differences in BCVA, CNV area and CMT of patients before and after treatment for 6 months were statistically significant (t=4.19, 3.96, 3.58; P<0.05).

Conclusions

OCTA could visually and clearly display the morphology of CNV lesions, and quantify indices such as CMT, CNV area, etc., which to provide a reference for anti-VEGF treatment and prognosis evaluation of wet AMD.

Key words: Optical coherence tomography angiography, Wet age-related macular degeneration, Conbercept, Choroidal neovascularization, Efficacy evaluation

表1 患者治疗前后不同时间点平均最佳矫正视力、脉络膜新生血管面积及视网膜厚度的比较(±s)

组别	眼数(只)	最佳矫正视力	脉络膜新生血管面积(mm²)	中央黄斑区视网膜厚度(μm)
治疗前	40	0.78±0.46	1.56±0.92	304.73±121.27
治疗后1 d	40	0.63±0.38^*	1.37±0.85^*	275.20± 91.81^*
治疗后3 d	40	0.56±0.37^*	1.30±0.85^*	263.90± 86.20^*
治疗后7 d	40	0.57±0.36^*	1.24±0.77^*	262.23± 81.88^*
治疗后1个月	40	0.63±0.41^*	1.26±0.81^*	261.68± 79.43^*
治疗后2个月	40	0.59±0.41^*	1.22±0.83^*	258.40± 79.11^*
治疗后3个月	40	0.60±0.42^*	1.22±0.75^*	241.00± 73.33^*
治疗后6个月	40	0.51±0.35^*	1.18±0.79^*	235.90± 62.18^*
F值		6.88	6.95	5.37
P值		<0.05	<0.05	<0.05

表1 患者治疗前后不同时间点平均最佳矫正视力、脉络膜新生血管面积及视网膜厚度的比较(±s)

组别	眼数(只)	最佳矫正视力	脉络膜新生血管面积(mm²)	中央黄斑区视网膜厚度(μm)
治疗前	40	0.78±0.46	1.56±0.92	304.73±121.27
治疗后1 d	40	0.63±0.38^*	1.37±0.85^*	275.20± 91.81^*
治疗后3 d	40	0.56±0.37^*	1.30±0.85^*	263.90± 86.20^*
治疗后7 d	40	0.57±0.36^*	1.24±0.77^*	262.23± 81.88^*
治疗后1个月	40	0.63±0.41^*	1.26±0.81^*	261.68± 79.43^*
治疗后2个月	40	0.59±0.41^*	1.22±0.83^*	258.40± 79.11^*
治疗后3个月	40	0.60±0.42^*	1.22±0.75^*	241.00± 73.33^*
治疗后6个月	40	0.51±0.35^*	1.18±0.79^*	235.90± 62.18^*
F值		6.88	6.95	5.37
P值		<0.05	<0.05	<0.05

图2 湿性年龄相关性黄斑变性伴2型脉络膜新生血管患者治疗前后的检查结果图　图2A和图2B分别示患者治疗前和治疗后6个月的眼底照相图；图2C和图2D分别示患者治疗前和治疗后6个月光学相干断层扫描黄斑区的成像；图2E和图2F分别示患者治疗前和治疗后6个月光学相干断层扫描血管成像扫描的血管成像；图2G和图2H分别示患者治疗前和治疗后6个月视网膜厚度的结果图

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Therapeutic effects of Conbercept on wet age-related macular degeneration using optical coherence tomography angiography

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Therapeutic effects of Conbercept on wet age-related macular degeneration using optical coherence tomography angiography