糖皮质激素联合降眼压药物治疗病理性近视合并多灶性脉络膜炎的临床疗效观察

doi:10.11958/20220588

摘要/Abstract

摘要：

目的观察口服糖皮质激素联合降眼压药物对合并多灶性脉络膜炎（MFC）的病理性近视（PM）患者近视发展的影响。方法合并MFC的PM患者56例（76眼），给予中等剂量糖皮质激素（醋酸泼尼松）口服治疗，平均疗程为13.5周;同时联合布林佐胺滴眼液滴眼24个月。于治疗后3、6、12、18及24个月进行随访，记录眼轴长度（AL）、等效球镜度（SE）、眼压、最佳矫正视力（BCVA）和视野平均敏感度（MS）。结果治疗后患者眼底彩像可见病变区域面积较治疗前稍减小，FFA荧光素渗漏程度较治疗前好转。与治疗前比较，治疗后3个月AL、SE、眼压差异无统计学意义，治疗后24个月AL、SE差异亦无统计学意义。与治疗前、治疗后3个月比较，治疗后6、12及18个月各指标差异均有统计学意义（P<0.05）;治疗后3、6、12和18个月时，各时点BCVA和视野MS比较差异均有统计学意义（P<0.05）。治疗后3、24个月，AL与眼压、SE均无相关性;治疗后6、12及18个月，AL与眼压呈正相关，与SE呈负相关（均P<0.01）。结论口服糖皮质激素联合降眼压药物治疗合并MFC的PM，可控制PM眼轴和近视屈光度的增长，有效改善视功能。

关键词: 近视，病理性, 糖皮质激素类, 临床方案, 多灶性脉络膜炎

Abstract:

Objective To observe the effect of oral glucocorticoid combined with ocular hypotensive drugs on the development of myopia in patients with pathologic myopia (PM) complicated with multifocal choroiditis (MFC). Methods A total of 56 PM patients (76 eyes) with MFC were collected, and they were treated with moderate-dose glucocorticoid (prednisone acetate) orally, with an average course of 13.5 weeks. At the same time, they were combined with brinzolamide eye drops for 24 months. Axial length (AL), spherical equivalent (SE), intraocular pressure, best corrected visual acuity (BCVA) and mean sensitivity of visual field ( mean sensitivity, MS) were followed-up and recorded at 3 months, 6 months, 12 months, 18 months and 24 months. Results After treatment, the color image of the fundus showed that the lesion area was slightly smaller than that before treatment, and the leakage of FFA fluorescein was improved compared with that before treatment. Compared with before treatment, there were no significant differences in AL, SE and intraocular pressure only at 3 months after treatment, and there were no significant differences in AL and SE at 24 months after treatment. Compared with before treatment and 3 months after treatment, there were significant differences in each index at 6, 12 and 18 months after treatment (P<0.05). There were significant differences in BCVA and visual field MS at different time points between 3, 6 and 24 months after treatment (P<0.05). At 3 and 24 months after treatment, there was no correlation between AL and intraocular pressure and SE. At 6, 12 and 18 months after treatment, AL was positively correlated with intraocular pressure and negatively correlated with SE (P<0.01). Conclusion Oral glucocorticoid combined with ocular hypotensive drugs to treat PM with MFC can control the growth of PM AL and myopia diopter, and effectively improve visual function.

Key words: myopia, degenerative, glucocorticoids, clinical protocols, multifocal choroiditis

中图分类号:

R778.11

图/表 3

表1 治疗前后AL、眼压、SE、BCVA和视野MS比较

Tab.1 Comparison of AL, IOP, SE, BCVA and MS before and after treatment

时间		n	AL（mm）		眼压（mmHg）
治疗前		76	29.03±1.03		19.08±2.78
治疗后3个月		76	29.02±1.03		19.61±2.44
治疗后6个月		76	28.30±0.98^ab		16.85±2.05^ab
治疗后12个月		76	28.55±0.98^abc		17.77±2.10^abc
治疗后18个月		76	28.78±0.99^abcd		17.08±2.28^abd
治疗后24个月		76	29.00±1.02^cde		16.76±1.91^abd
F			154.340^＊＊		18.681^＊＊
时间	SE			BCVA		视野MS（dB）
治疗前	-12.37±（-1.66）			0.55±0.20		14.35±1.60
治疗后3个月	-12.24±（-1.70）			0.42±0.17^a		14.57±1.65^a
治疗后6个月	-11.22±（-1.62）^ab			0.28±0.12^ab		15.32±1.59^ab
治疗后12个月	-11.33±（-1.59）^ab			0.31±0.13^abc		16.63±1.36^abc
治疗后18个月	-12.01±（-1.67）^abcd			0.39±0.16^abcd		16.21±1.45^abcd
治疗后24个月	-12.03±（-1.70）^bcd			0.37±0.16^abcd		14.65±1.69^acde
F	7.286^＊＊			101.550^＊＊		399.331^＊＊

图1 治疗前后眼底彩像和FFA图 A~D：病例1左眼治疗前后对比。A：治疗前眼底彩像，后极部可见大片脉络膜萎缩病灶，视盘鼻侧可见一局部色素紊乱区（箭头示）;B：治疗前FFA，可见视盘鼻侧色素紊乱区域呈高荧光（箭头示）;C：治疗后眼底彩像，色素紊乱区域面积减小（箭头示）;D：治疗后FFA，鼻侧高荧光减弱（箭头示）。E~H：病例2右眼治疗前后对比。E：治疗前眼底彩像，后极部可见大片脉络膜萎缩病灶，黄斑区可见小片状及纵行带状色素紊乱区域（箭头示）;F：治疗前FFA，后极部可见片状及带状部高荧光伴部分渗漏（箭头示）;G：治疗后眼底彩像，后极部色素紊乱区域面积减小，边界较前清晰（箭头示）;H：治疗后FFA，后极部高荧光范围缩小，渗漏减轻（箭头示）。

Fig.1 Fundus color and FFA before and after treatment

表2 治疗后各时间点AL与眼压、SE的相关性分析

Tab.2 Correlation analysis of AL with intraocular pressure and SE at each time point after treatment

治疗后	AL与眼压	AL与SE
3个月	0.010	-0.034
6个月	0.610^＊＊	-0.597^＊＊
12个月	0.638^＊＊	-0.626^＊＊
18个月	0.654^＊＊	-0.523^＊＊
24个月	0.095	-0.060

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