OCTA在雷珠单抗治疗慢性中心性浆液性脉络膜视网膜病变合并CNV的临床应用

Role of Optical Coherence Tomography Angiography in Chronic Central Serous Chorioretinopathy with CNV after Intravitreal Injections of Ranibizumab

摘要: 目的：在OCTA指导下观察玻璃体腔注射雷珠单抗治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC)合并CNV的临床疗效。方法：选取2016/07~2018/03我院确诊的9例9眼慢性CSC合并CNV的患者，按照“3 + PRN”方案给予玻璃体腔注射0.5 mg/0.05 mL雷珠单抗治疗。治疗后每月随访病情，随访时间为6 mo，观察指标包括治疗前后的最佳矫正视力(best-corrected visual acuity, BCVA)、眼压以及通过光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)观察的黄斑中心凹厚度(central macular thinkness, CMT)和脉络膜新生血管(choroidal neovascularization, CNV)的面积。结果：患者9例9眼中，雷珠单抗玻璃体腔注药前9眼患者CMT平均值为373.12 ± 72.43 μm，雷珠单抗治疗后1 w、1 mo、3 mo、6 mo时CMT分别为346.42 ± 65.32、332.05 ± 67.13、282.24 ± 62.30、225.56 ± 71.08 μm，与治疗前相比均具有统计学差异(P < 0.05)。玻璃体腔注药前9眼患者CNV面积平均值为1.13 ± 0.23 mm2，治疗后1 w、1 mo、3 mo、6 mo时CNV面积平均值分别为1.05 ± 0.32、0.85 ± 0.13、0.65 ± 0.30、0.65 ± 0.25 mm2，与治疗前相比均具有统计学差异(P < 0.05)。治疗前BCVA为0.30±0.12，注射后1 w、1 mo、3 mo、6 mo的BCVA分别为0.43 ± 0.21、0.45 ± 0.15、0.50 ± 0.06、0.55 ± 0.20，与治疗前相比均具有统计学差异(P < 0.05)。结论：玻璃体腔注射雷珠单抗治疗慢性CSC合并CNV疗效显著、安全性高；患者玻璃体腔注射雷珠单抗可以有效促进视网膜下液的吸收，降低CMT，可以促进CNV的吸收消退，提高视力。OCTA能无创、快速获得视网膜和脉络膜血管图像，为诊断慢性CSC合并CNV和监控其治疗效果提供有力证据。

Abstract: AIM: To observe the clinical efficacy of intravitreal injection of ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC) with CNV under the guidance of OCTA. Methods: Nine patients with 9 eyes with chronic CSC and CNV diagnosed in our hospital from 2016/07 to 2018/03 were treated with intravitreal injection of 0.5 mg/0.05 mL of ranibizumab. The patients were followed up every month for 6 months after treatment. The observed indicators included best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), and choroidal neovascularization (CNV) area by optical coherence tomography angiography (OCTA). Results: In 9 eyes of 9 patients, the average CMT of 9 eyes before injection in the vitreous cavity was 373.12 ± 72.43 μm, and the CMT at 1 w, 1 mo, 3 mo and 6 mo after treatment with razurizumab was 346.42 ± 65.32, 332.05 ± 67.13, 282.24 ± 62.30, 225.56 ± 71.08 μm. There was a statistical difference (P < 0.05) compared with that before treatment. The average CNV area of the 9 eyes before injection in the vitreous cavity was 1.13± 0.23 mm2. The average CNV area at 1 w, 1 mo, 3 mo and 6 mo after treatment was 1.05 ± 0.32, 0.85 ± 0.13, 0.65 ± 0.30, 0.65 ± 0.25 mm2, respectively. There was a statistical difference (P < 0.05) compared with before treatment. The BCVA before treatment was 0.30 ± 0.12, and the BCVA at 1 w, 1 mo, 3 mo and 6 mo after injection were 0.43 ± 0.21, 0.45 ± 0.15, 0.50 ± 0.06 and 0.55 ± 0.20, respectively, which were statistically different compared with before treatment (P < 0.05). Conclusion: Intravitreal injection of ranibizumab in the treatment of chronic CSC combined with CNV has a significant and safe effect; the patient’s intravitreal injection of ranibizumab can effectively promote the absorption of subretinal fluid, reduce CMT, can promote the absorption of CNV, and improve vision. OCTA provides non-invasive, rapid acquisition of retinal and choroidal blood vessel images, providing strong evidence for the diagnosis of chronic CSC with CNV and monitoring of its therapeutic effects.