中华眼底病杂志

中华眼底病杂志

新生血管性老年性黄斑变性及近视性脉络膜新生血管患眼抗血管内皮生长因子药物治疗前后光相干断层扫描血管成像对比观察

查看全文

目的 对比观察新生血管性老年性黄斑变性(nAMD)及近视性脉络膜新生血管(mCNV)患眼抗VEGF药物治疗前后光相干断层扫描血管成像(OCTA)特征。 方法 前瞻性队列研究。2017年5~12月在四川大学华西医院眼科诊断为nAMD的29例患者37只眼及mCNV 31例患者34只眼纳入研究。nAMD患者中,男性19例,女性10例;平均年龄(68.20±8.76)岁。mCNV患者中,男性9例,女性22例;平均年龄(43.10±11.80)岁,平均屈光度(−9.71±1.20)D。所有患眼均行玻璃体腔注射康柏西普或雷珠单抗0.05 ml(含康柏西普或雷珠单抗0.5 mg)治疗。治疗后随访时间3~6个月。治疗前及治疗后1 d、1周、1个月及后续每个月均行OCTA检查,每次扫描均采用跟踪模式,保证扫描位置为同一部位。对比分析nAMD、mCNV患眼治疗前后CNV病灶面积、中心凹旁表层视网膜血管密度及血流灌注的情况。 结果 nAMD患眼治疗前及治疗后1个月CNV病灶面积分别为(0.38±1.87)、(0.06±0.12)mm2;mCNV患眼治疗前及治疗后1个月CNV病灶面积分别为(0.26±1.06)、(0.03±0.05)mm2。nAMD与mCNV患眼治疗前、治疗后1个月CNV病灶面积比较,差异均有统计学意义(Z=4.181、4.475,P<0.001)。nAMD与mCNV患眼治疗后1个月CNV病灶面积较治疗前面积变化绝对值(Z=1.853,P=0.064)、面积变化百分比(t=2.685,P=0.010)比较,差异均有统计学意义。与治疗前相比,nAMD患眼治疗后3个月中心凹旁表层视网膜血管密度(F=8.997,P=0.003)及血流灌注(F=7.887,P=0.015)处于明显降低状态;mCNV患眼治疗后1 d即可观察到中心凹旁表层视网膜血管密度(F=11.142,P=0.004)及血流灌注(F=7.662,P=0.013)降低,治疗后1个月时有所回升。 结论 nAMD及mCNV患眼CNV病灶面积及抗VEGF药物治疗后病灶缩小程度存在明显不同。抗VEGF药物治疗对nAMD及mCNV患眼中心凹旁表层视网膜血管密度及血流灌注的影响也存在差异。

Objective To compare the features of OCT angiography (OCTA) between neovascular age-related macular degeneration (nAMD) and myopic choroidal neovascularization (mCNV) patients before and after intravitreal anti-VEGF treatment. Methods A prospective cohort study. Twenty-nine patients (37 eyes) with nAMD (19 males and 10 females, aged 68.20±8.76) and 31 patients (34 eyes) with mCNV (9 males and 22 females, aged 43.10±11.80, with the mean diopter of −9.71±1.20 D) from Department of Ophthalmology, West China Hospital of Sichuan University during May and December 2017 were included in this study. Ranibizumab or Conbercept (0.5 mg/0.05 ml) was intravitreally injected in all eyes. The patients were follow-up for 3−6 months. The OCTA was conducted before treatment and 1 day, 1 week, 1 month and 3−6 months after treatment. In order to ensure that the scanning position was the same, the tracking mode was adopted for each scanning. According to the OCTA images, the lesion area, parafoveal superficial vessel density and perfusion area were measured and analyzed contrastively between nAMD and mCNV patients. Results The mean lesion area before and 1 month after treatment in nAMD patients were 0.38±1.87 mm2 and 0.06±0.12 mm2, while in mCNV patients, those were 0.26±1.06 mm2 and 0.03±0.05 mm2, respectively. There were statistically significant differences (Z=4.181, 4.475; P<0.001) in CNV lesion area before and 1 month after treatment between nAMD and mCNV patients. Compared with those before treatment, the absolute change (Z=1.853, P=0.064) and the percentage changes (t=2.685, P=0.010) of CNV lesion area 1 month after treatment in nAMD and mCNV patients show a statistical meaning. There were significantly decreases in both parafoveal superficial vessel density (F=8.997, P=0.003) and perfusion area (F=7.887, P=0.015) 3 months after treatment in nAMD patients, while decreases in parafoveal superficial vessel density (F=11.142, P=0.004) and perfusion area (F=7.662, P=0.013) could be detected 1 day after treatment in mCNV patients, before rising 1 month after treatment. Conclusions There are significantly differences in lesion area before and after the treatment of intravitreal anti-VEGF between nAMD and mCNV patients by OCTA examination. Moreover, the changes of both parafoveal superficial vessel density and perfusion area after anti-VEGF treatment are statistically different in two groups.

关键词: 湿性黄斑变性; 脉络膜新生血管化; 体层摄影术,光学相干; 血管生成抑制剂/治疗应用; 抗体,单克隆/治疗应用

Key words: Wet macular degeneration; Choroidal neovascularization; Tomography, optical coherence; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use

引用本文: 闵晓雪, 刘依琳, 周思睿, 牟佳, 张明. 新生血管性老年性黄斑变性及近视性脉络膜新生血管患眼抗血管内皮生长因子药物治疗前后光相干断层扫描血管成像对比观察. 中华眼底病杂志, 2019, 35(1): 36-39. doi: 10.3760/cma.j.issn.1005-1015.2019.01.008 复制

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Bressler NM. Age-related macular degeneration is the leading cause of blindness[J]. JAMA, 2004, 291(15): 1900-1901. DOI: 10.1001/jama.291.15.1900.
2. Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review[J]. Am J Ophthalmol, 2014, 157(1): 9-25. DOI: 10.1016/j.ajo.2013.08.010.
3. Xu D, Dãvila JP, Rahimi M, et al. Long-term progression of type 1 neovascularization in age-related macular degeneration using optical coherence tomography angiography[J]. Am J Ophthalmol, 2018, 187: 10-20. DOI: 10.1016/j.ajo.2017.12.005.
4. Cheng Y, Li Y, Huang X, Qu Y. Application of optical coherence tomography angiography to assess anti-vascular endothelial growth factor therapy in myopic choroidal neovascularization[J/OL]. Retinal, 2017, 2017: E1[2017-12-18]. https://insights.ovid.com/crossref?an=00006982-900000000-96633. DOI: 10.1097/IAE.0000000000002005. [published online ahead of print].
5. Amoaku WM, Chakravarthy U, Gale R, et al. Defining response to anti-VEGF therapies in neovascular AMD[J]. Eye, 2015, 29(6): 721-727. DOI: 10.1038/eye.2015.48.
6. Miere A, Butori P, Cohen SY, et al. Vascular remodeling of choroidal neovascularization after anti-vascular endothelial growth factor therapy visualized on optical coherence tomography angiography[J/OL]. Retina, 2017, 2017: E1[2017-11-23]. https://insights.ovid.com/crossref?an=00006982-900000000-96687. DOI: 10.1097/IAE.0000000000001964. [published online ahead of print].
7. Iafe NA, Phasukkijwatana N, Sarraf D. Optical coherence tomography angiography of type 1 neovascularization in age-related macular degeneration[J]. Dev Ophthalmol, 2016, 56: 45-51. DOI: 10.1159/000442776.
8. Mastropasqua L, Toto L, Borrelli E, et al. Optical coherence tomography angiography assessment of vascular effects occurring after aflibercept intravitreal injections in treatment-naive patients with wet age-related macular degeneration[J]. Retina, 2017, 37(2): 247-256. DOI: 10.1097/IAE.0000000000001145.
9. 孙姣, 王艳玲, 王佳琳. 光相干断层扫描血管成像在近视中的应用研究进展[J]. 中华眼底病杂志, 2018, 34(1): 83-86. DOI: 10.3760/cma.j.issn.1005-1015.2018.01.025.Sun J, Wang YL, Wang JL. Advances of optical coherence tomography angiography in myopia[J]. Chin J Ocul Fundus Dis, 2018, 34(1): 83-86. DOI: 10.3760/cma.j.issn.1005-1015.2018.01.025.
10. 黎晓新, 石璇. 认识光相干断层扫描血管成像技术特色, 提升光相干断层扫描血管成像技术临床应用水平[J]. 中华眼底病杂志, 2017, 33(1): 3-6. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.002.Li XX, Shi X. Clinical applications of optical coherence tomography angiography[J]. Chin J Ocul Fundus Dis, 2017, 33(1): 3-6. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.002.
11. Toto L, Borrelli E, Di A L, et al. Retinal vascular plexuses' changes in dry age-related macular degeneration, evaluated by means of optical coherence tomography angiography[J]. Retina, 2016, 36(8): 1566-1572. DOI: 10.1097/IAE.0000000000000962.
12. Mo J, Duan A, Chan S, et al. Vascular flow density in pathological myopia: an optical coherence tomography angiography study[J/OL]. BMJ Open, 2017, 7(2): e013571[2017-02-03]. DOI: 10.1136/bmjopen-2016-013571.