| ObjectiveTo evaluate the clinical efficacy of Ranibizumab in the treatment of choroidal neovascularization(CNV)in patients with neovascular age-related macular degeneration(n AMD)of different TCM syndrome types.MethodsA retrospective study was conducted in the Department of Ophthalmology of the affiliated Hospital of Chengdu University of traditional Chinese Medicine from January 2019 to January 2020.40patients(40 eyes)with n AMD were diagnosed by fundus fluorescein angiography(FFA)and/or indocyanine green angiography(ICGA)and optical coherence tomography(OCT).According to TCM syndrome types,they were divided into liver and kidney deficiency syndrome,dampness-heat accumulation syndrome,collateral injury bleeding syndrome and qi and blood deficiency syndrome.According to the results of OCT and FFA,the neovascularization was classified as typeⅠ,typeⅡand typeⅢCNV.According to the clinical guidelines of anti-VEGF,Ranibizumab was treated with"3+PRN"regimen(single-dose 0.5mg/0.05ml).The best corrected visual acuity((BCVA))was observed 1 week and 1-6 months after treatment,the central retinal thickness(CRT)was measured by OCT,and the CNV area was measured by optical coherence tomography(OCTA).The statistical methods were T-test of independent samples of measurement data,and SPSS23.0 statistical software was used to analyze the data.Results1. General data:40 cases(40 eyes)were included in this study.There were 21 cases of right eye and 19 cases of left eye;There were11 cases between 50 and 59 years old,12 cases from 60 to 69 years old,13 cases from 60 to 79 years old,4 cases over 80 years old 21 eyes of21 males and 19 eyes of 19 females.2. CNV classification:20 cases(50%)in typeⅠCNV group,20 cases(50%)in typeⅡCNV group,and 0 cases(0%)in typeⅢCNV group.3. TCM syndrome types:liver and kidney deficiency syndrome 14 cases(35%),damp-heat accumulation syndrome 16 cases(40%),collateral injury bleeding 10 cases(25%),qi and blood deficiency syndrome 0cases(0%).In liver and kidney deficiency syndrome,there were 8 cases of typeⅠCNV(20%),6 cases of typeⅡCNV(15%),8 cases of damp-heat accumulation syndrome(20%),8 cases of typeⅡCNV(20%),4 cases of typeⅠCNV(10%)and 6 cases of typeⅡCNV(15%).4. Results of BCVA(Log MAR)detection after treatment with Ranibizumab:(1)TypeⅠCNV:increased by0.16±0.09 in 1 week,0.20±0.17 in3 months,0.18±0.18 in 6 months.(2)TypeⅡCNV:increased 0.19±0.11,0.31±0.16 and 0.30±0.23 in 1 week,3 months and 6 months respectively.5. Results of CRT(um)detection after treatment with Ranibizumab:(1)TypeⅠCNV:decreased 55.70±17.56 in 1 week,67.55±31.17 months,65.10±27.68 in 6 months.(1)TypeⅡCNV:decreased 123.20±44.53 in 1week,189.95±88.13 in 3 months,194.65±89.60 in 6 months compared with baseline CRT.6. The results of CNV area(mm~2)after Ranibizumab treatment were as follows:(1)typeⅠCNV:decreased by 0.32±0.09 at 1 week,0.37±0.15 at3 months and 0.33±0.18 at 6 months after treatment.(2)TypeⅡCNV:decreased by 0.45±0.20 in 1 week,0.59±0.32 in 3 months and 0.57±0.33in 6 months compared with baseline.7. Comparison of different types of CNV after treatment with Ranibizumab:(1)There was no significant difference in visual acuity between typeⅡCNV group and type 2 CNV group(p>0 05).There was no significant difference in visual acuity between typeⅠCNV group and typeⅡCNV group.(2)CRT:the decrease of CRT in typeⅡCNV group was higher than that in typeⅠCNV group(P<0.05).(3)CNV area:the reduction of CNV area in typeⅡCNV group was larger than that in typeⅠCNV group(p<0 05).(4)There was no significant difference in the effective rate of visual acuity between typeⅠCNV and typeⅡCNV85%(p>0.05)8. Comparison of different TCM syndrome types after Ranibizumab treatment:there was no significant difference in the area of BCVA,CRT and CNV among different TCM syndrome types after Leizumab treatment.The effective rate of visual acuity of liver and kidney deficiency syndrome was 78.57%,damp-heat accumulation syndrome was 75%,and collateral injury hemorrhage syndrome was 80%.There was no significant difference in visual acuity among different TCM syndrome types(p>0.05).9. Safety:after treatment,only 1 patient had transient elevated intraocular pressure,1 patient had mild subconjunctival hemorrhage,and no other abnormalities were found.Conclusion(1)Ranibizumab is safe and effective in the treatment of n AMD.(2)The morphological changes of typeⅡCNV treated with Ranibizumab are better than those of type I CNV.(3)The main syndrome types of traditional Chinese medicine are deficiency of liver and kidney,accumulation of dampness and heat,and collateral injury and hemorrhage.Ranibizumab is effective in all n AMD patients of TCM syndrome type,but the therapeutic effect has no difference among different TCM syndrome types. |
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