Carrola Gonçalo, Lima-Fontes Mário, Falcão-Reis Fernando, Figueira Luís, Carneiro Ângela
Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Ophthalmology, São João Hospital University Centre, Porto, Portugal.
J Ophthalmol. 2021 Jul 23;2021:9982883. doi: 10.1155/2021/9982883. eCollection 2021.
To characterise a sample of patients with inflammatory choroidal neovascularization (I-CNV), including clinical profile, underlying aetiology and its course, treatments performed, associated clinical response, and visual prognosis.
Retrospective analysis of patients with a diagnosis of I-CNV followed at the Ophthalmology Department of (CHUSJ). Clinical and visual outcomes were classified according to the difference in visual acuity after treatment.
Twenty eyes from 17 patients were analysed (11 female and 6 male patients, mean age 41.90 ± 16.457 years at CNV diagnosis). Punctate inner choroidopathy/multifocal choroiditis was the predominant inflammatory aetiology (10 patients, 58.82%). Median follow-up time was 46 months (range 10 to 188 months). Neovascularization was treated with intravitreal anti-VEGF injections (bevacizumab, aflibercept, and ranibizumab), and inflammation with anti-inflammatory/immunosuppressive therapy (oral, intravenous, and/or intravitreal corticosteroids; oral cyclosporine or methotrexate). Intravitreal anti-VEGF agents had a median number of 7.00 injections (IQR, 4.25 to 29.00). Visual acuity among 20 eyes had a mean gain of 15.10 ± 12.998 ETDRS letters after anti-VEGF treatment (=0.000051). According to our classification, 16 had an improved outcome (80.00%), 3 had a stable outcome (15.00%), and 1 had a worsened visual outcome (5.00%). In addition, 13 eyes (65.00%) had a final VA equal to or greater than 65 letters. Recurrence was seen in 3 eyes (15.00%). Complications included cataract (6 patients) and ocular hypertension (4 patients).
A combined approach with anti-VEGF agents and anti-inflammatory therapy was effective in I-CNV treatment, and an overall good visual prognosis was attainable. Intensive follow-up was fundamental in the management of both the primary inflammatory and secondary neovascular conditions.
对炎症性脉络膜新生血管（I-CNV）患者样本进行特征分析，包括临床特征、潜在病因及其病程、所进行的治疗、相关临床反应和视力预后。
对在（CHUSJ）眼科接受随访的诊断为I-CNV的患者进行回顾性分析。根据治疗后视力差异对临床和视力结果进行分类。
分析了17例患者的20只眼（11例女性和6例男性患者，CNV诊断时平均年龄41.90±16.457岁）。点状内层脉络膜病变/多灶性脉络膜炎是主要的炎症病因（10例患者，58.82%）。中位随访时间为46个月（范围10至188个月）。采用玻璃体内注射抗VEGF药物（贝伐单抗、阿柏西普和雷珠单抗）治疗新生血管，采用抗炎/免疫抑制疗法（口服、静脉注射和/或玻璃体内注射皮质类固醇；口服环孢素或甲氨蝶呤）治疗炎症。玻璃体内抗VEGF药物的注射次数中位数为7.00次（IQR，4.25至29.00）。20只眼中，抗VEGF治疗后视力平均提高了15.10±12.998 ETDRS字母（P = 0.000051）。根据我们的分类，16只眼预后改善（80.00%），3只眼预后稳定（15.00%），1只眼视力预后恶化（5.00%）。此外，13只眼（65.00%）最终视力等于或大于65字母。3只眼（15.00%）出现复发。并发症包括白内障（6例患者）和高眼压（4例患者）。
抗VEGF药物与抗炎治疗相结合的方法对I-CNV治疗有效，可获得总体良好的视力预后。强化随访对于原发性炎症和继发性新生血管疾病的管理至关重要。
