玻璃体内注射膨胀性气体联合贝伐单抗治疗新生血管性年龄相关性黄斑变性所致黄斑下出血

PURPOSE

To evaluate the results of intravitreal expansile gas injection, with or without recombinant tissue plasminogen activator (rtPA), followed by intravitreal bevacizumab injection for treatment of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (AMD).

METHODS

In this interventional case series, 5 eyes of 5 patients with SMH secondary to choroidal neovascularization (CNV) due to neovascular AMD were treated with 0.3 cc intravitreal SF6 (and 50 μg of rtPA in two eyes), followed by face-down positioning; 24 hours later, 1.25 mg of bevacizumab was injected intravitreally. Main outcome measures included displacement of SMH and best corrected visual acuity (BCVA).

RESULTS

Mean patient age was 75.6±9.2 (range, 60-83) years, mean duration of symptoms was 6.4±3.2 (range, 3-10) days, and mean number of bevacizumab injections was 1.8 (range, 1-3). Mean preoperative BCVA was 1.28±0.27 logMAR which improved significantly to 0.57±0.33 logMAR at 12 months (P=0.042). SMH displacement occurred in all eyes, and visual acuity improved and remained stable during the follow-up period of 12 months.

CONCLUSION

Intravitreal expansile gas injection, with or without rtPA, followed by intravitreal bevacizumab injection, seems to be an effective modality for SMH displacement and treatment of the underlying CNV in neovascular AMD.

目的

评估玻璃体内注射膨胀性气体联合或不联合重组组织型纤溶酶原激活剂（rtPA），随后玻璃体内注射贝伐单抗治疗新生血管性年龄相关性黄斑变性（AMD）继发的黄斑下出血（SMH）的效果。

方法

在这个干预性病例系列中，对5例因新生血管性AMD导致脉络膜新生血管（CNV）继发SMH的患者的5只眼进行了治疗，玻璃体内注射0.3 cc的SF6（两只眼还注射了50 μg的rtPA），然后面部朝下体位；24小时后，玻璃体内注射1.25 mg贝伐单抗。主要观察指标包括SMH的移位和最佳矫正视力（BCVA）。

结果

患者平均年龄为75.6±9.2（范围60 - 83）岁，平均症状持续时间为6.4±3.2（范围3 - 10）天，平均贝伐单抗注射次数为1.8（范围1 - 3）。术前平均BCVA为1.28±0.27 logMAR，在12个月时显著改善至0.57±0.33 logMAR（P = 0.042）。所有眼均发生了SMH移位，在12个月的随访期内视力改善并保持稳定。