Clinical Observation Of The Effect Of Intravitreal Injection Ranibizumab Treatment For Macular Area Choroid Neovascularization

Objective:To observe the clinical efficacy of intravitreal injection of ranib-izumab for 1 year treating choroid neovascularization (CNV) secondary to age-r elated macular degeneration (AMD) and high myopia(HM) macular degeneratio-n.Methods:A retrospective study,79eyes of 73 patients (38 eyes of 35 AMD pa-tients and 41 eyes of 38 HM patients) with CNV were collected from July 2 012 to April 2014 in teaching hospital of Chengdu T.C.M. (Traditional Chines-e Medicine). All cases were taken ophthalmofundoscopy, fundus fluorescein an-giograph (FFA) and (or) indocyanine green angiography (ICGA), optical cohere-nce tomography (OCT), and auto-fluorescence (AF) examination and treated o-nly with 0.05 ml (0.5 mg/0.05ml) intravitreal rannibizumab. Best-corrected visu-al acuity (BCVA), OCT, AF and ophthalmoscope examination were assessed b-efore and after the first injection. All of the patients received an initial intravi-treal injection of ranibizumab (0.5 mg,0.05 ml) and followed by repeated injec-tions over the 12 months follow-up on the basis of central retina thickness (C RT) and angiographic features. Using SPSS 19.0 statistical software to compar-ed the change of the BCVA and CRT before and after treatment. Paired-Samp-1 es T Test were used. X2-insp-ection were used to analyse the resu-1-t of AF. Di-fference was statistically significant or there was relationship be-tween the rows and columns when P< 0.05. It is effective when vision improved equal or m-ore than 1 row,otherwise the opposite. Facilitate statistics, decimal vision was converted to LogMAR visual acuity. LogMAR=Log(1/decim-al vision).Results:1AMD1.1 BCVACompared with pre-injection,all differences were statistically significant(P< 0.05) at each observative point. The BCVA of 24 eyes increased(63.16%),5 eyes unincreased(13.16%) and 9 eyes declined(23.68%). Total effective rate was 63.16%.1.2 CRT 12 month post-injection 480.61±322.51 55.76±185.05-1.858 0.071Compared with pre-injection, all differences were statistically significant(P < 0.05) at each observative point.1.3 GAPre-injection, there were 20 patients has bioncular GA,6 patients binocul-ar hasn’t found GA,12 patients has monocular GA. The independence test dis-plays that there has relationship between the two eyes with GA in one patient (P=0.043<0.05. The coefficient of association is C=0.325.One year after the first injection, The GA expand in 26 eyes (with 1.96± 0.87 injections), and 12 eyes have unconspicuous changes in GA (with 1.67±0. 49 injections). There is no significant difference between two groups (Z=-0.88 5, P=0.376>0.05).1.4 adverse reaction Intraocular pressure didn’t risen in all patients after the injection. There were six patients had the slight ophthalmecchymosis, and after four days it has be absorbed. No retinoschisis, retinal detachment, entophtha-lmia and other topical adverse events were observed. No serious systemic were observed.1.5 syndrome differentiation of T.C.M.2 HM2.1 BCVACompared with pre-injection, all differences were statistically significant (P< 0.05) at each observative point. The BCVA of 26 eyes increased (63.41%),9 eyes unincreased (21.95%) and 6 eyes declined (14.63%). Total effective rate was 63.41%.2.2 CRTPre-injection,there were 14 patients has binocular GA,24 patients binocul-ar hasn’t found GA,13 patients has monocular GA. The independence test dis-plays that there has relationship between the two eyes with GA in one patient (X2=5.214, P=0.022<0.05. The coefficient of association is C=0.377.One year after the first injection, The GA expand in 17 eyes (with 1.71± 0.77 injections), and 24 eyes have unconspicuous changes in GA (with 1.67±0. 87 injections). There is no significant difference between two groups (Z=-0.33 4, P=0.739>0.05).2.4 adverse reaction Intraocular pressure didn’t risen in all HM patients after the injection. There were four patients had the slight ophthalmecchymosis, and after seven days it has be absorbed. Iris depigmentation and anterior chamber benefly appear in one of them, and after fuor days the anterior chamber ben-efly disappeared. No retinoschisis, retinal detachment, entophthalmia and other t-opical adverse events were observed. No serious systemic were observed. One patient has slight retinoschisis after one year, and before treatment his other e-ye had retinoschisis.2.5 syndrome differentiation of T.C.M.Conclusion:(1) Lucentis for the treatment of macular area choroid neovascular ization (AMD, HM) is safe and effective in 1 year follow-up period. (2) GA developed in the majority of eyes with or without using Lucentis, but in this paper, there is no sufficient evidence to prove that GA progress caused by anti-VEGF drugs.(2) AMD patients are typed as liver and kidney deficiency syndrome, damp a-bundance due to spleen asthenia syndrome and blood stasis resistance collater-als syndrome, and are closely related with liver, spleen and kidney; High myo-pia patients are typed as liver and kidney deficiency, qi-blood deficiency, damp abundance due to spleen asthenia syndrome and flaming-up of asthenic fire f-our types, and are closely related with the heart, liver, spleen, kidney; In short, their main etiology and pathogenesis is deficiency syndrome.