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玻璃体内注射抗血管内皮生长因子(VEGF)和曲安奈德在放射性视乳头病变治疗中的应用

The Use of Intravitreal Anti-VEGF and Triamcinolone in the Treatment of Radiation Papillopathy.

作者信息

Roelofs Kelsey, Larocque Matthew P, Murtha Albert, Weis Ezekiel

机构信息

Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada.

Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Ocul Oncol Pathol. 2018 Nov;4(6):395-400. doi: 10.1159/000487543. Epub 2018 Jun 8.

Abstract

BACKGROUND/AIMS: To evaluate a treatment regimen for radiation papillopathy.

METHODS

This is a prospective noncomparative interventional case series of patients who developed radiation papillopathy after plaque brachytherapy for uveal melanoma. Treatment consisted of intravitreal bevacizumab (IVB) (1.25 mg in 0.05 mL) at the time of diagnosis, and 1 week later, intravitreal triamcinolone (IVK) (2.00 mg in 0.05 mL). One month later, patients again received both IVB and IVK. Patients were then switched to monotherapy with monthly IVB until the papillopathy resolved.

RESULTS

Eleven patients developed radiation papillopathy, with 9 receiving treatment. On multivariate analysis, total radiation dose to the optic nerve was the only significant predictor of papillopathy ( = 0.005). Four of nine patients presented with a significant decline in visual acuity (VA) at the time of diagnosis of papillopathy. In all 4, significant improvement was documented following treatment. Five patients did not present with a decrease in VA, and in this group, 80% remained stable with treatment.

CONCLUSIONS

In this series, patients who had a precipitous drop in VA at the time of diagnosis of radiation papillopathy returned to baseline VA following this treatment algorithm. This protocol was effective at maintaining stability of VA in 80% of those who developed papillopathy but did not present with an acute drop in VA.

摘要

背景/目的:评估放射性乳头病变的一种治疗方案。

方法

这是一个前瞻性非对照干预性病例系列,纳入了因葡萄膜黑色素瘤接受斑块近距离放疗后发生放射性乳头病变的患者。治疗方案为在诊断时玻璃体内注射贝伐单抗(IVB)(0.05 mL含1.25 mg),1周后玻璃体内注射曲安奈德(IVK)(0.05 mL含2.00 mg)。1个月后,患者再次接受IVB和IVK注射。然后患者改用每月一次的IVB单药治疗,直至乳头病变消退。

结果

11例患者发生放射性乳头病变,9例接受了治疗。多因素分析显示,视神经的总放疗剂量是乳头病变的唯一显著预测因素(P = 0.005)。9例患者中有4例在乳头病变诊断时视力(VA)显著下降。在所有4例患者中,治疗后视力均有显著改善。5例患者视力未下降,在这组患者中,80%在治疗后视力保持稳定。

结论

在本系列中,放射性乳头病变诊断时视力急剧下降的患者按照该治疗方案治疗后视力恢复至基线水平。该方案对80%发生乳头病变但视力未急性下降的患者有效维持了视力稳定。

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