Systemic Bevacizumab as an Adjuvant Therapy for Idiopathic Polypoidal Choroidal Vasculopathy: A Case Report

使用靜脈注射Bevacizumab做為原發性息肉狀脈絡膜血管病變的輔助治療－病例報告

張鈞凱(Chun-Kai Chang) ； 鄭成國(Cheng-Kuo Cheng)

《中華民國眼科醫學會雜誌》 48卷3期 (2009/12) Pp. 312-318

https://doi.org/10.30048/ACTASOS.200912.0012

摘要

目的：病例報告靜脈注射Bevacizumab治療原發性息肉狀脈絡膜血管病變。
方法：病例報告。
結果。56歲女性因右眼視力模糊，經眼底螢光與循血綠血管攝影診斷為右眼原發性息肉狀脈絡膜血管病變。光學同調斷層攝影顯示黃斑部囊狀水腫併視網膜下積水。5次玻璃體內Bevacizumab注射變，視網膜下積水局部消退，視力下降至6/60。因此，進行一次經靜脈注射Bevacizumab。一個月後，視網膜下積水完全吸收。靜脈注射二個月後，視網膜下積水復發，再施行4次玻璃體內Bevacizumab藥物注射與一次光動力療法，但積水未消。故進行第二次經靜脈注射Bevacizumab，視網膜下積水在2週內完全吸收。最終視力為2/60。過程中，無任何眼部或全身性副作用產生。
結論：靜脈注射Bevacizumab治療原發性息肉狀脈絡膜血管病變是一種安全有效的輔助療法。

並列摘要

Purpose: To report a case of idiopathic polypoidal choroidal vasculopathy (IPCV) treated by systemic bevacizumab therapy.
Method: An interventional case report.
Results: A healthy 56-year-old healthy female suffered from decreased best-corrected visual acuity (BCVA) OD as of 6/15 for 1 year. IPCV of OD was diagnosed by fluorescein angiography (FAG) and indocyanine-green angiography (ICG). Cystic macular edema, subretinal fluid and increased central retinal thickness (CRT) (395μm) were found by optical coherence tomography (OCT). Five courses of intravitreal injection of 2.5mg bevacizumab were given, but the subretinal fluid absorbed partially and the CRT was 278μm two months after the 5th injection. After discussion with the patient, intravenous infusion of 5mg/kg of bevacizumab was done smoothly, and the subretinal fluid resolved completely. The CRT decreased to 142μm in 1 month. FAG showed decreased dye leakage; however, the IPCV lesions still persisted. After another four courses of intravitreal injection of 2.5mg bevacizumab and one session of photodynamic therapy (PDT) within 10 months, the subretinal fluid reaccumulated and the CRT increased to 268μm. A second course of systemic bevacizumab with the same dosage was completed, and the subretinal fluid resolved within 2 weeks. The patient tolerated the therapy well, and no ocular or systemic side effect was noted during the follow-up period. The final vision was 2/60 and the final CRT was 195μm.
Conclusions: Systemic bevacizumab is a safe and probably effective way for the treatment of IPCV. It may be an adjuvant therapy other than intravitreal injection of bevacizumab or photodynamic therapy for the management of IPCV.

並列關鍵字

idiopathic polypoidal choroidal vasculopathy ； systemic bevacizumab ； subretinal fluid ； intravitreal bevacizumab