激光治疗湿性老年性黄斑变性的临床观察

老年性黄斑变性（ＡＭＤ）是６５岁以上老年人视力丧失的常见原因，随着年龄增加，其发病率呈上升趋势。我们发现ＡＭＤ患者经激光治疗后２４个月视力均在００６以上，最佳视力达０５，而观察组视力均在００１以下（Ｐ＜００５）。眼底荧光血管造影（ＦＦＡ）检查示治疗组７１４％新生血管（ＣＮＶ）完全消退，２８６％有ＣＮＶ残存或复发，前者较后者平均视力少下降２６行（Ｐ＜００５），而观察组ＦＦＡ表现病灶扩大，视力下降。表明激光治疗可减少患者视力下降的危险性，能有效保持患者的视力。     

玻璃体腔内注射Avastin治疗老年性黄斑变性引起的脉络膜新生血管

年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种严重威胁老年人视功能的眼底疾病,随着抗VEGF药物(avastin)的诞生,治疗该病显现出蓬勃的发展趋势,它不但可以延缓脉络膜新生血管(choroidal neovascularization,CNV)的进展,还可以提高视力。现将avastin治疗AMD中CNV的相关应用作一综述。     

玻璃体腔注射Avastin治疗老年性黄斑变性引起的CNV

目的:研究玻璃体腔内注射阿瓦斯汀(Avastin)治疗老年性黄斑变性(age-related macular degeneration,AMD)中脉络膜新生血管(choroidal neovascularization,CNV)的临床效果与安全性。方法:选择我科2009-01/2010-12经眼底血管造影(fundus fluorescein angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT)确诊存在黄斑中心凹下CNV的患者60例60眼作为观察对象。玻璃体腔内注射Avastin1.25mg,每6wk注射一次。记录治疗后1,2,3d;3wk;3,6mo BCVA、眼压、晶状体、玻璃体的变化,观察脉络膜渗漏情况和黄斑中心凹视网膜厚度(central foveal thickness,CFT),进行比较。结果:患者共60例,其中男26例26眼,女34例34眼,平均年龄62岁。治疗前患者的基线平均对数BCVA为logMAR1.15±0.41,CFT为395.92±94.39μm。注药后第1d BCVA有明显提高(logMAR0.86±0.43),1wk后CFT也有明显改善332.50±68.35μm,经平均6mo的随访,BCVA(logMAR0.71±0.37),CFT(250.23±35.33μm),两项指标均较基线有显著改善。本组患者共接受了113次玻璃体腔内注射,平均注射次数为1.88次/眼。治疗过程中未发现严重不良反应。结论:玻璃体腔内注射Avastin治疗湿性AMD引起的CNV安全、副作用少,可改善患者的视功能,减轻黄斑水肿,减少CNV渗漏。     

光动力疗法治疗老年性黄斑变性合并脉络膜新生血管的临床观察

目的 观察单次光动力疗法(photodynamic therapy, PDT)治疗渗出型老年性黄斑变性(age-related macular degeneration, AMD)合并脉络膜新生血管(choroidal neovascularization, CNV)的短期治疗效果。 方法 回顾分析经荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)和光相干断层成像术(optic coherence tomography, OCT)等检查确诊的30例渗出型AMD患者的35只患眼行PDT治疗前和治疗后1周,1、3个月的临床资料，以视力、FFA、ICGA和OCT检查结果为观察指标，评价PDT对渗出型AMD的短期治疗效果。 结果 治疗后3 个月内有34只眼视力不变或提高，1只眼因出血而视力下降；FFA检查显示有19只眼荧光素渗漏减轻或完全消退；OCT检查显示视网膜水肿和浆液性脱离明显好转。全部患者治疗过程中未发生任何不良反应；治疗后3例患者主诉有一过性视物变暗，2例主诉轻微背痛。 结论 PDT治疗渗出型AMD时，可短期封闭CNV，使渗漏减轻或消退，对视力无损害。 (中华眼底病杂志, 2002, 18: 171-174)     

经瞳孔温热疗法治疗老年性黄斑变性的疗效观察

目的 观察经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗渗出型老年性黄斑变性(age—related macular degeneration，AMD)隐匿型脉络膜新生血管(choroidal neovascularization，CNV)的效果。方法 对28例34眼经眼底荧光血管造影(fundus fluorescein angiography，FFA)及吲哚青绿血管造影(indocyanine green angiography，ICGA)确诊的继发于渗出型AMD的隐匿型CNV行TTT治疗，并主要以视力、眼底检查、FFA及ICGA改变为指标，评价TTT治疗渗出型AMD的效果。结果 随访3～20个月，平均6.65个月，视力提高19眼，视力稳定13眼，视力下降2眼，视网膜水肿基本消退6眼，水肿明显减轻21眼，水肿无明显变化5眼，2眼水肿加重，出血吸收22眼，8眼出血减少，出血无明显变化者2例，另有2眼发生少量新鲜视网膜深层出血，第1次治疗后复查FFA及ICGA，10眼CNV消失，19眼CNV渗漏减轻，3眼无明显变化，2眼CNV增大。结论 TTT治疗可使大部分AMD患者视力稳定或提高，是一种极具潜力的治疗方式，但对其确切疗效的评价。尚需与自然病程及其他治疗方法对比。     

比较雷珠单抗和贝伐珠单抗对新生血管AMD的疗效

目的：比较玻璃体内注射雷珠单抗与贝伐珠单抗对年龄相关性黄斑变性（ age-related macular degeneration, AMD）的疗效,治疗方案必要时采用。 方法：回顾性分析63例63眼（雷珠单抗治疗组35眼,贝伐珠单抗治疗组28眼）新确诊新生血管年龄相关性黄斑变性患者的资料。治疗12 mo后随访,分析比较两组患者的最佳矫正视力（ BCVA）和黄斑中心凹厚度（ CFT）。采用双尾t检验和单因素方差分析比较两组最佳矫正视力和黄斑中心凹厚度的变化。 结果：雷珠单抗治疗组35眼和贝伐珠单抗治疗组28眼均完成12 mo随访,并记录数据。雷珠单抗治疗组最佳矫正视力均值增加0.1 logMAR;相反,贝伐珠单抗治疗组最佳矫正视力均值下降0.06logMAR（P=0.01）。雷珠单抗治疗组13眼（37%）和贝伐珠单抗治疗组4眼（14%）最佳矫正视力至少增加0.3logMAR。雷珠单抗治疗组平均黄斑中心凹厚度减少41.6μm,贝伐珠单抗治疗组减少8.1μm（P=0.003）。两组平均注射次数是4.46次和4.11次（P〉0.05）。 结论：玻璃体内注射雷珠单抗组在视力和消水肿方面疗效优于贝伐珠单抗组。但是,两种药的疗效和安全性还需要随机的长期临床试验来验证。     

老年性黄斑变性光学相干断层扫描观察

目的 观察萎缩型，渗出型老年黄斑变性（Age-related macular degeneration AMD）患者的光学相干断层扫描图像特征。比较光学相干断层扫描（Optical Coherence Tomography OCT）和荧光血管造影（Fluorescein angiography FFA）的特点，对脉络膜新生血管（Choroidal neovascularization CNV）进行OCT分型。方法 经FFA确诊的AMD57例76只眼进行OCT检查。结果 AMD患者色素上皮萎缩，软性玻璃膜疣，神经上皮和色素上皮脱离具有特有的OCT特征，OCT图像中视网膜神经上皮增厚、隆起反映视网膜下，视网膜层间积液。神经上皮或色素上皮（Retinal pigment epithelium，RPE）隆起，其下低反射区反映神经上皮或RPE层脱离。CNV的OCT图像分为边界清晰的CNV，边界模糊的CNV，纤维血管性RPE脱离。FFA中的典型性CNV相当于OCT图像中边界清晰CNV，隐匿性CNV相当于OCT图像中边界模糊CNV和纤维血管性RPE脱离。结论 OCT能特征性显示AMD中视网膜神经上皮隆起，视网膜层间积液，出血，神经上皮和RPE的脱离，且显示不同类型CNV的OCT特征。     

玻璃体腔内注射Bevacizumab治疗湿性年龄相关性黄斑变性的临床应用

湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)是以黄斑区出现脉络膜新生血管膜(choroidal neovascularization,CNV)为特点,血管内皮生长因子(vascular endothelial growth factor,VEGF)是目前已知促新生血管形成最主要的刺激因子,VEGF抑制剂通过拮抗作用,抑制血管生成、降低血管通透性,促进CNV渗液的吸收.Bevacizumab虽然存在药物标识外使用(off-label)问题,它对湿性AMD仍以相对好的短期治疗效果和低廉的治疗成本在国际眼科界被广泛应用.玻璃体腔内1个月注射1次Bevacizumab(1.25 mg),连续注射3次的方案优于注射1次后再根据病情再次注射的方案.治疗后湿性AMD患者眼底解剖结构和视力均有明显改善.     

老年性黄斑变性脉络膜新生血管与脉络膜分水带

目的 观察老年性黄斑变性（age-related macular degeneration ,AMD）的脉络膜新生血管(choroidal neovascularization,CNV)与黄斑区脉络膜分水带(choroidal watershed zones，CWZ)的关系。 方法 对比分析AMD 患者57例57只眼以及与之年龄相匹配的无AM D的患者35例35只眼的吲哚青绿血管造影（indocyanine green angiography, ICGA)资料，观 察CNV与黄斑区CWZ的关系。 结果 57只AMD眼中，35只眼有黄斑区CWZ，占61.4%；对照组35只眼中，3只眼有黄斑区CWZ，占8.57%，两者比较差异有显著性的意义（P<0.05)。在有CNV的43只渗出型AMD眼中，32只眼有黄斑区CWZ，占74.4%，其中29只眼的CNV来自黄斑区 CWZ，占90.6%。 结论 黄斑区CWZ可能是渗出型AMD的CNV好发部位。 （中华眼底病杂志，2003，19：76-78）     

老年性黄斑变性的放射治疗

老年性黄斑变性是与年龄相关的一种严重的不可逆性致盲眼病,常因脉络膜新生血管形成导致中心视力的迅速下降。由于致病机制未明,目前仍无有效的治疗方法。20世纪90年代以来,国外展开了使用小剂量放射治疗抑制脉络膜新生血管的临床研究,初步结果显示该方法能抑制脉络膜新生血管的生长,并发症较少。对放射治疗的原理、技术、在老年性黄斑变性（ARMD）治疗中的临床应用效果、并发症等作一综述。     

Intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to age-related macular degeneration in an Indian population

Purpose To investigate the 6-month safety profile and clinical outcomes of intravitreal bevacizumab for treating subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods We performed a prospective nonrandomized interventional study of 40 consecutive patients (40 eyes) with subfoveal CNV due to AMD. Patients underwent standard ophthalmic examination, optical coherence tomography, and fundus fluorescein angiography. All patients were administered one or more intravitreal injections of bevacizumab (1.25 mg) as primary therapy. Outcomes were also analyzed in subgroups based on lesion type (classic or occult) and lesion size (≤3000 μm or >3000 μm). Results At the 6 months’ follow-up, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/100 (P = 0.014), and the mean contrast sensitivity improved from 0.38 to 0.62 (P = 0.001). The mean greatest linear diameter and mean central macular thickness significantly decreased from 3.79 mm to 2.4 mm (P = 0.0001) and from 438.5 μm to 363 μm (P = 0.0001), respectively. Visual acuity gain of 15 letters or more was seen in 20% of patients, and the gain was more in the small-lesion subgroup (31.5%) than in the large-lesion subgroup (9.5%). No significant adverse effects were observed. Conclusion Intravitreal bevacizumab is a safe and effective modality for treatment of CNV secondary to AMD. A significant improvement in BCVA with intravitreal bevacizumab was observed for all lesion types.     

玻璃体内注射Avastin治疗年龄相关性黄斑变性的研究进展

新生血管性年龄相关性黄斑变性（age—related macular degeneration．AMD）是老年人严重的不可逆性致盲眼病．抗-血管内皮生长因子（vascular endothelial growth factor．VEGF）疗法是目前治疗该病的最新方法之一。Avastin是针对VEGF所有亚型的人源化全长单克隆抗体。最近大量研究表明,采用玻璃体内注射Avastin治疗新生血管性AMD具有价格低廉、短期内效果良好、无严重全身或眼部并发症等优点．但仍需进一步多中心临床随机对照研究．以证实这一疗法长期应用的安全性和有效性．并明确重复治疗的标准。     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.     

年龄相关性黄斑变性治疗方法研究

年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种导致老年人视力减退和失明的主要疾病,对老年人及其家庭成员的身心健康产生严重影响。我们在分析AMD临床特点及发病机制基础上,对目前应用于临床的最新AMD治疗方法进行综述,并对各种治疗方法的适应性和局限性进行阐述和说明。     

康柏西普玻璃体腔注射治疗渗出型老年性黄斑变性的疗效

目的：观察玻璃体腔内注射康柏西普治疗渗出型老年黄斑变性的临床疗效。
　　方法：前瞻性研究。渗出型老年黄斑变性患者112例112眼,随机分为研究组和对照组,各56例56眼,研究组患者采用玻璃体腔内注射康柏西普治疗,对照组采用保守治疗,观察治疗前后两组患者裸眼视力及黄斑中心凹视网膜厚度。
　　结果：研究组患者治疗后视力明显提高,且治疗后6mo 提高最明显。研究组患者治疗后黄斑中心凹视网膜厚度均减低,且治疗后6mo 减低最明显。
　　结论：玻璃体腔内注射康柏西普能有效提高渗出型老年黄斑变性患者视力,降低黄斑中心凹厚度。     

年龄相关性黄斑变性治疗新进展

年龄相关性黄斑变性是发达国家中老年人群主要致盲眼病,其患病率逐年上升。近年来其治疗方面取得很大进展。预防性治疗以抗氧化剂为代表,近来也出现了一些新的治疗方法,如他汀类药物等。抗CNV的治疗重心由激光治疗转为从转录及表达水平针对VEGF及其受体的治疗。联合治疗是研究CNV治疗新的发展方向,多项试验验证了PDT联合抗VEGF治疗的有效性。但是手术治疗CNV作为一项补充的治疗措施,其疗效需要更多的随机对照临床试验验证。     

Comparing outcomes in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration treated with two different doses of primary intravitreal bevacizumab: results of the pan-american collaborative retina study group (PACORES) at the 12-month follow-up

Purpose  To compare the total number of injections and the anatomic and best-corrected visual acuity (VA) response after injecting 1.25 or 2.5 mg of bevacizumab as needed in patients with primary choroidal neovascularization secondary to age-related macular degeneration (AMD) at 12 months. Methods  This was a retrospective, interventional, comparative multicenter study of 60 eyes treated with intravitreal bevacizumab (35 eyes, 1.25 mg; 25 eyes, 2.5 mg). Results  The mean number of injections per eye was 3.8 in the 1.25-mg group and 3.2 in the 2.5-mg group (P = 0.2752). At 12 months, in the 1.25-mg group, 16 (46%) eyes gained ≥3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) VA and seven (20%) lost ≥3 lines of ETDRS VA. In the 2.5-mg group, 11 (44%) eyes improved by ≥3 lines, and four (16%) lost ≥3 lines (P = 1.000). At 12 months, in the 1.25-mg group, the mean central macular thickness decreased from 419 ± 201 μm at baseline to 268 ± 96 μm, compared with a decrease from 388 ± 162 to 296 ± 114 μm in the 2.5-mg group (P = 0.7896). Conclusion  There were no statistically significant differences between the two dose groups with regard to the number of injections, anatomic and VA outcomes. For a complete listing of participating members of PACORES see Appendix