目的：了解高海拔地区湿性老年性黄斑变性(wet age-related macular degeneration，wAMD)患者注射雷珠单抗(Ranibizumab)前后房水中血管内皮生长因子(vascular endothelial growth factor，VEGF)含量的变化，探讨VEGF浓度与黄斑中心凹视网膜厚度的相关性。

方法：回顾性分析2014-06/2015-10来我院就诊，经最佳矫正视力、眼压、眼底检查、眼底彩色照相、荧光素眼底血管造影(fundus fluorescein angiography，FFA)、光相干断层扫描(optic coherence tomography，OCT)检查确诊为wAMD的患者76例76眼纳入治疗。其中男46眼，女30眼； 年龄40～80(平均55±11.18)岁，病程0.3～6mo，矫正视力0.01～0.6，平均眼压15.24±3.12mmHg。入选患者全部脉络膜新生血管(choroidal neovascularization，CNV)在距黄斑中心凹500μm范围内。在表面麻醉下给予0.5mg雷珠单抗注射液玻璃体腔内注射。治疗前和治疗后1mo抽取前房房水0.1mL，行ELISA检测前房房水中VEGF浓度。治疗后监测患者的最佳矫正视力、裂隙灯显微镜、眼压、OCT检查、眼底血管造影检查。收集行白内障手术无CNV的76患者作为正常对照组，所有白内障患者无虹膜新生血管、玻璃体混浊、视网膜脱离等眼部疾病，排除糖尿病、高血压等全身慢性病。

结果：治疗后1mo临床疗效最好，差异有统计学意义(P<0.05)； wAMD患者房水中VEGF含量(95.48±50.09pg/mL)较正常对照组(43.01±16.17pg/mL)明显升高； 治疗后1mo房水中VEGF浓度(31.89±14.14pg/mL)较治疗前明显降低，差异有统计学意义(P<0.05)； 房水中VEGF浓度与中心凹视网膜的厚度具有正相关性，差异有统计学意义(P<0.05)。

结论：对于wAMD患者，雷珠单抗注射液有良好的治疗效果； 治疗后能够使视网膜中心凹厚度明显变薄、降低房水中VEGF的浓度； 并且房水中VEGF浓度与中心凹视网膜的厚度具有正相关性。

AIM: To study the concentration of vascular endothelial growth factor(VEGF)in aqueous humor in patients with wet age-related macular degeneration(wAMD)before and after Ranibizumab treating at high altitude and the correlation of VEGF concentration with central fovea macula thickness.

METHODS: The patients with wAMD in our hospital from Jun. 2014. to Oct. 2015 were retrospectively analyzed, diagnosed after best corrected visual acuity, intraocular pressure, fundus examination, fundus color photography, fluorescence fundus angiography(FFA)and optical coherence tomography(OCT)inspection. Seventy- six patients with cataract without choroidal neovascularization(CNV)were selected as control group. In the 76 patients(76 eyes), 46 were male, 30 were female, aged 40-80(55±11.18). The course was 0.3-6mo. The corrected visual acuity was 0.01-0.6. The intraocular press was 15.24±3.12mmHg. The CNV in all cases was within the range of the 500μm in diameter. Under surface anesthesia, Ranibizumab(0.5mg)was injected into vitreous cavity. Before and after injection, aqueous humor was obtained and used to detect the concentration of VEGF through ELISA. Best corrected visual acuity, slit lamp microscope, intraocular pressure, OCT and FFA were observed after treatment.

RESULTS:The clinical curative effect is the best at 1mo after treatment with statistical significance(P<0.05). The concentration of VEGF in aqueous humor in wAMD patients before treatment(95.48±50.09pg/mL)was higher than that of control group(43.01±16.17pg/mL). The concentration of VEGF decreased at 1mo after treatment as 31.89±14.14pg/Ml(P<0.05). The concentration of VEGF was positive related with central fovea macula thickness(P<0.05).

CONCLUSION: For wAMD patients, Ranibizumab injection is effective for it reduces the concentration of VEGF in aqueous humor and the central fovea macula thickness. The VEGF concentration in aqueous humor and foveal retinal thickness has a positive correlation.

青海省科技厅(No.2014-ZJ-762)