天津医药

天津医药 ›› 2026, Vol. 54 ›› Issue (7): 747-750.doi: 10.11958/20260528

• 临床研究 • 上一篇    下一篇

纤维血管性视网膜色素上皮脱离患者抗VEGF治疗后色素上皮撕裂的特征因素分析

孟斌(), 刘昕, 郭寅, 吉昂()   

  1. 北京市海淀医院（北京大学第三医院海淀院区）眼科 （邮编100029）
  • 收稿日期:2026-02-28 修回日期:2026-04-13 出版日期:2026-07-15 发布日期:2026-07-13
  • 通讯作者: △E-mail：jiang4815@139.com
  • 作者简介:孟斌（1978），男，副主任医师，主要从事眼底病和葡萄膜炎方面研究。E-mail：ykysmb1230@163.com

Analysis of characteristic factors for retinal pigment epithelial tears in patients with fibrovascular retinal pigment epithelial detachment after anti-vascular endothelial growth factor therapy

MENG Bin(), LIU Xin, GUO Yin, JI Ang()   

  1. Department of Ophthalmology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing 100029, China
  • Received:2026-02-28 Revised:2026-04-13 Published:2026-07-15 Online:2026-07-13
  • Contact: △E-mail：jiang4815@139.com

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摘要：

目的 评估纤维血管性视网膜色素上皮脱离（fv-RPED）患者抗血管内皮生长因子（VEGF）治疗后发生视网膜色素上皮（RPE）撕裂的特征因素。方法 纳入确诊为fv-RPED并接受抗VEGF治疗的患者76例（76眼），根据是否发生RPE撕裂分为撕裂组（9例）和未撕裂组（67例）。收集RPE撕裂患者接受抗VEGF药物种类及撕裂前注射次数、末次注射至RPE撕裂的间隔时间。采集RPE撕裂前末次就诊和撕裂后首次就诊的最佳矫正视力（BCVA）。应用光学相干断层扫描（OCT）测量所有患者治疗前fv-RPED高度及最大水平直径，并分析RPE撕裂患者治疗前的影像学特征。结果 撕裂组患者年龄、fv-RPED高度和最大水平直径均高于未撕裂组（P<0.05）。9例RPE撕裂患者中，抗VEGF药物种类包括0.5 mg雷珠单抗3例、0.5 mg康柏西普4例、2 mg阿柏西普1例及8 mg阿柏西普1例。撕裂前平均注射次数为（3.5±1.2）次。撕裂发生阶段：6例发生于前3次负荷治疗期内，3例发生于病变复发活动阶段。末次注射至RPE撕裂的中位间隔时间为21 d。患眼RPE撕裂前平均早期治疗糖尿病视网膜病变研究（ETDRS）视力为（59.1±4.4）个字母，撕裂后下降至（37.6±8.4）个字母（P<0.05）。9例撕裂患者均表现为明显的RPE皱褶，5例可见RPE-脉络膜新生血管（CNV）复合体下低反射裂隙，2例存在RPE微裂孔。结论 高龄、较高的fv-RPED高度、较高的fv-RPED最大水平直径以及有RPE皱褶、RPE-CNV复合体下低反射裂隙和RPE微裂孔的fv-RPED患者抗VEGF治疗后易发生RPE撕裂。

关键词: 血管内皮生长因子类, 体层摄影术, 光学相干, 视网膜色素上皮撕裂, 纤维血管性视网膜色素上皮脱离

Abstract:

Objective To evaluate the characteristic factors for retinal pigment epithelial (RPE) tears in patients with fibrovascular retinal pigment epithelial detachment (fv-RPED) after anti-vascular endothelial growth factor (VEGF) therapy. Methods A total of 76 patients (76 eyes) diagnosed with fv-RPED and received anti-VEGF treatment were enrolled. Patients were divided into the tear group (9 cases) and the non-tear group (67 cases) according to the occurrence of RPE tears. Data of types of anti-VEGF drugs received by patients with RPE tear, the number of injections before the tear and the interval time from the last injection to the RPE tear were collected. Best-corrected visual acuity (BCVA) was recorded at the last visit before the tear and at the first visit after the tear. Optical coherence tomography (OCT) was used to measure the height and maximum horizontal diameter of fv-RPED in all patients before treatment, and the imaging features of patients with RPE tear before treatment were analyzed. Results Age, fv-RPED height and maximum horizontal diameter were significantly higher in the tear group than those in the non-tear group (all P<0.05). Among the 9 patients with RPE tears, the anti-VEGF agents administered included ranibizumab 0.5 mg (3 cases), conbercept 0.5 mg (4 cases), aflibercept 2 mg (1 case) and aflibercept 8 mg (1 case). The mean number of injections before the tear was 3.5±1.2. Six tears occurred during the initial three loading doses, and three occurred during the reactivation phase. The median interval from the last injection to the RPE tear was 21 days. The mean ETDRS letter score decreased from 59.1±4.4 before the tear to 37.6±8.4 after the tear (P<0.05). All 9 cases showed obvious RPE folds. A hyporeflective cleft beneath the RPE-choroidal neovascularization (CNV) complex was observed in 5 cases, and RPE microrips were present in 2 cases. Conclusion Risk factors for RPE tears in fv-RPED patients after anti-VEGF treatment include advanced age, larger fv-RPED dimensions, and OCT features such as RPE folds, a hypo-reflective cleft beneath the RPE-CNV complex and RPE micro-rips.

Key words: vascular endothelial growth factors, tomography, optical coherence, retinal pigment epithelial tear, fibrovascular retinal pigment epithelial detachment

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