目的:通过对400例眼底病患者520眼经玻璃体腔注射avastin治疗的临床疗效观察,说明玻璃体腔注射avastin对视网膜静脉阻塞(RVO)、糖尿病性视网膜病变(DR)、年龄相关性黄斑变性(ARMD)、中心性浆液性脉络膜视网膜病变(CSC)、视网膜脉络膜新生血管(CNV)等眼底病的治疗能起到重要的作用,并对其副作用作了总结分析统计。方法:对我院门诊确诊为RVO,DR,ARMD,CSC,CNV等眼底病患者400例眼底病患者520眼进行玻璃体腔注射avastin治疗,注射治疗1次/mo,以治疗前后的视力、眼底荧光血管造影(FFA)、眼压、光学相干断层扫描(OCT)作为观察指标,对经玻璃体腔注射avastin治疗的疗效进行分析总结;并对治疗过程当中出现的并发症作了总结、分析。结果:随访时间为3mo～1a,520眼中有467眼(89.8%)视力提高2行以上,眼压正常、视网膜水肿及出血明显吸收,新生血管消退,OCT及FFA指标都有好转;36眼(6.9%)视力稳定,治疗前后视力无变化,但眼底情况都有改善,无新生血管增生加重或眼压升高等并发症的发生;17眼(3.3%)视力下降,其中有13眼(2.5%)从0.2降至0.1,病变稳定;1眼(0.2%)发生了眼内炎,视力从0.6下降至0.2;1眼(0.2%)发生了视网膜中央动脉阻塞(CRAO),视力从0.02变为光感;1眼(0.2%)发生了玻璃体出血;1眼(0.2%)发生了孔源性视网膜脱离,伴有并发症而视力下降的患者中除了1眼(CRAO)外其余在对症治疗后视力均有提高;在所有的治疗眼中发生一过性眼压升高20眼(3.8%),后经降眼压对症治疗后眼压正常。还有1例患者右眼行玻璃体腔注射avastin治疗后3d左眼施行了小梁切除手术,术后切口愈合较一般手术后慢7～10d,眼压相对较低。结论:经玻璃体腔注射avastin治疗视RVO,DR,ARMD,CSC,CNV等眼底病,是一种有效、安全的方法,能提高视力,减轻黄斑和视网膜水肿,促进玻璃体和视网膜下出血的吸收,能有效地消退视网膜和脉络膜新生血管,可以抑制虹膜红变和新生血管性青光眼的发生;对于在治疗过程中出现的并发症也是值得我们去总结、思考的。

AIM:To investigate the clinical efficacy of and side effects of intravitreal injection of Avastin for retinal vein occlusion(RVO),diabetic retinopathy(DR),age-related macular degeneration(ARMD),central serous chorioretinopathy (CSC),retinal choroidal neovascularization (CNV). METHODS:Totally 400 cases 520 eyes of fundus disease diagnosed by outpatient including RVO,DR,ARMD, CSC,CNV and other retinal patients underwent intravitreal injection of avastin,and once every month. The visual acuity,fundus fluorescein angiography(FFA), intraocular pressure,optical coherence tomography (OCT) were observed before and after the treatment,and the complications were summarized and analyzed. RESULTS:Following up for 3 months to 1 year,467 eyes (89.8%) had a normal intraocular pressure and improved OCT and FFA indicators,and with visual acuity improved above 2 lines,retinal edema and bleeding absorption, neovascularization regression;36 eyes(6.9%) with stable visual acuity and improved fundus situation,no neovascularization or increased intraocular pressure and other complications;17 eyes(3.3%) with visual acuity decreased,including 13 eyes(2.5%) from 0.2 to 0.1; One eye(0.2%) had endophthalmitis,visual acuity decreased from 0.6 to 0.2;One eye(0.2%) occurred central retinal artery occlusion,visual acuity changed from 0.02 to light perception;One eye(0.2%) had vitreous hemorrhage;One eye(0.2%) had retinal detachment; The visual acuity was improved without one eye associated with complications of central retinal artery occlusion;All 20 eyes(3.8%) had transient elevation of intraocular pressure,while the intraocular pressure reduce to normal by symptomatic treatment;One eye underwent trabeculectomy surgery after intravitreal injection of avastin treatment,with wound healing time from 7 to 10 days and low intraocular pressure. CONCLUSION:Intravitreal injection of avastin for RVO, DR,ARMD,CSC,CNV is an effective,safe method,and can improve visual acuity and reduce macular and retinal edema,vitreous and retinal hemorrhage;and promote the absorption of effective regression of retinal and choroidal neovascularization;and can inhibit the red iris changes and the occurrence of neovascular glaucoma.

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