目的：分析病理性高度近视并发脉络膜新生血管进行抗血管内皮细胞生长因子(vascular endothelial growth factor，VEGF)单独治疗与光动力疗法(photodynamic therapy，PDT)单独治疗后黄斑视网膜厚度的变化，探寻脉络膜新生血管的高效治疗方法。

方法：选取2014-11-1/2015-06-30于我院治疗的43例45眼病理性高度近视并发脉络膜新生血管患者，通过对不同治疗方法患者的病历资料回顾性分析进行疗效比较，采用抗VEGF单独治疗的20例22眼患者设为观察组，采用PDT治疗的23例23眼患者设为对照组。比较治疗后6mo两组患者患眼视力状况，并进行光学相干断层扫描(optical coherence tomography，OCT)检查比较黄斑区视网膜厚度、脉络膜新生血管(choroidal neovascularization，CNV)强反射区域变化和视网膜下液吸收情况，采用荧光素眼底血管造影术(fluorescein fundus angiography，FFA)、吲哚菁绿血管造影(indocyanine green angiography，ICGA)检查CNV渗漏情况，并比较两组患者治疗前后CNV突破视网膜色素上皮(retinal pigment epithelium，REP)的宽度、高度、离中心凹的距离和不良反应发生情况。

结果：观察组视力提高两行及以上眼数比例为82%，显著高于对照组(74%)，差异有统计学意义(P<0.05)； OCT检查两组患者治疗前黄斑区视网膜厚度，经比较差异无统计学意义(P>0.05)，治疗后均显著降低，观察组显著低于对照组，差异有统计学意义(P<0.05)； FFA、ICGA检查观察组CNV停止渗漏眼数比例为86%，渗漏减少14%，与对照组(74%，22%)比较，差异有统计学意义(P<0.05)； 观察组不良反应发生率为14%，与对照组(17%)比较，差异无统计学意义(P>0.05)； 治疗后两组患者CNV突破RPE的宽度、高度、离中心凹的距离均降低，且观察组显著低于对照组，差异有统计学意义(P<0.05)。

结论：相较于PDT治疗，抗VEGF单独治疗能显著提升病理性高度近视并发CNV患者的视力，降低黄斑区视网膜厚度，CNV停止渗漏效果更佳。

METHODS: The clinical data of 43 pathologic myopia patients(45 eyes)complicated with CNV treated in our hospital from November 1, 2014 to June 30, 2015 were retrospectively analyzed and their curative effect of different treatment methods were compared through the analysis. In them, 20 patients(22 eyes)treated with anti-VEGF alone were set as the observation group and 23 patients(23 eyes)treated with PDT were set as the control group. The visual acuity of the two groups after 6mo of treatment was compared, and OCT examination was performed to compare their macular retinal thickness, CNV strong reflection of regional changes and subretinal fluid absorption. The fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were used to compare the CNV leakage and the adverse reactions between the two groups. The width, height, distance from the fovea and the incidence of adverse reactions of the CNV breakthrough retinal pigment epithelium(RPE)before and after treatment were compared between the two groups.

RESULTS: The eye ratio of the visual acuity in the observation group increased by two lines was 82%, which was significantly higher than 74% of the control group, and the difference was statistically significant(P<0.05); OCT showed no significant difference in retinal thickness before treatment between the two groups(P>0.05), but after the treatment, the retinal thickness was significantly lower in the observation group than in the control group(P<0.05). The FFA and ICGA examination showed that the proportion of CNV in the observation group was 86%, and the leakage was reduced by 14%, which was significantly different from that in the control group(74%, 22%), and the difference was statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 14% and 17% in the control group, there was no significant difference between two groups(P>0.05). After treatment, the width, height and distance from the fovea of the CNV breakthrough RPE of both groups decreased, and the observation group was significantly lower than that of the control group(P<0.05).

CONCLUSION: Compared with PDT treatment, anti-VEGF treatment alone can significantly improve the visual acuity of patients with pathologic myopia complicated with CNV, reduce macular retinal thickness with a better effect of stopping leakage.