息肉状脉络膜血管病变治疗中国指南（2022）

陈有信; 张誉清; 陈长征; 戴虹; 李甦雁; 马翔; 孙晓东; 唐仕波; 王雨生; 魏文斌; 文峰; 徐格致; 于伟泓; 张美霞; 赵明威; 张阳; 齐方; 许迅; 黎晓新

doi:10.24920/004213

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息肉状脉络膜血管病变治疗中国指南（2022）

中国医学科学杂志（英文） 2023年38卷第2期页码：77-93

Guideline & Consensus | Updated：2024-06-12

- 息肉状脉络膜血管病变治疗中国指南（2022）
- Affiliations：
  
  1. 1Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  2. 2Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  3. 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  4. 4Ningbo Nottingham GRADE center, University of Nottingham, Ningbo, China
  5. 5Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
  6. 6CEBIM (Center for Evidence Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
  7. 7Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
  8. 8Department of Ophthalmology, Beijing Hospital, Beijing, China
  9. 9Department of Ophthalmology, Xuzhou Municipal Hospital Affiliated to Xuzhou medical University, Xuzhou, China
  10. 10Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
  11. 11Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  12. 12Aire Eye Hospital, Changsha, China
  13. 13Department of Ophthalmology, Xijing Hospital, Fouth Military Medical University, Xi‘an, China
  14. 14Department of Ophthalmology, Beijing Tongren Hospital, Beijing, China
  15. 15State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  16. 16Ophthalmology, the Affiliated Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
  17. 17Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
  18. 18Department of Ophthalmology, Peking University People’s Hospital, Beijing, China
  19. 19Department of Ophthalmology, Peking University People’s Hospital, Beijing, China
  20. 20Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
  21. 21Eye Center of Xiamen University, Xiamen, China
  22. 22People Eye Center of People’s Hospital, Peking University, Beijing, China
- Author bio：
  
  *Xun Xu, E-mail: drxuxun@sjtu.edu.cn;
  Xiaoxin Li, E-mail: dr_lixiaoxin@163.com
- Funds：
- DOI：10.24920/004213
  中图分类号：
- 录用日期：2023-04-06，
  
  网络出版日期：2023-05-31，
  
  纸质出版日期：2023-06-30
- Accepted：
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陈有信, 张誉清, 陈长征, 等. 息肉状脉络膜血管病变治疗中国指南（2022）[J]. 中国医学科学杂志（英文）, 2023,38(2):77-93.

You-Xin Chen, Yu-Qing Zhang, Chang-Zheng Chen, et al. Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)[J]. Chinese medical sciences journal, 2023, 38(2): 77-93.
陈有信, 张誉清, 陈长征, 等. 息肉状脉络膜血管病变治疗中国指南（2022）[J]. 中国医学科学杂志（英文）, 2023,38(2):77-93. DOI： 10.24920/004213.

You-Xin Chen, Yu-Qing Zhang, Chang-Zheng Chen, et al. Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)[J]. Chinese medical sciences journal, 2023, 38(2): 77-93. DOI： 10.24920/004213.

摘要

背景

在中国，新生血管性年龄相关黄斑变性患者中约有40%患有多灶性脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）。PCV会导致反复视网膜色素上皮脱离（pigment epithelium detachment

PED）、广泛的视网膜下或玻璃体内出血，以及严重的视力损失。近年来，已有多种该病的治疗方法在中国使用，临床医生需要获得治疗PCV的全面经验。

方法

由14名具有专业背景的眼科专家形成指南专家组，重点关注如下方面问题和相应的结局：非活动性PCV患者的治疗选择；未经治疗的PCV患者的治疗选择，包括抗血管内皮生长因子（vascular endothelial growth factor，VEGF）单药治疗、光动力疗法（photodynamic therapy，PDT）单药治疗或联合治疗；抗VEGF负荷治疗后仍有持续性视网膜下液（subretinal fluid，SRF）或视网膜内液（intraretinal fluid，IRF）的患者，以及伴有大量视网膜下出血的患者的治疗选择。证据整合团队在各个问题下进行系统评价，为推荐意见的形成提供依据。本指南采用GRADE方法评估证据的可信性，并确定推荐的强度。

结果

指南专家组共形成了以下六条弱强度推荐意见：（1）对于非活动性PCV患者，建议观察而非立即治疗；（2）对于未经治疗的PCV患者，建议采用抗VEGF单药治疗或抗VEGF联合PDT，而非单独使用PDT；（3）对于拟进行抗VEGF联合PDT治疗的PCV患者，建议采用延迟/挽救PDT而非起始联合PDT；（4）对于拟进行抗VEGF单药治疗的P

CV患者，建议在完成三个月负荷治疗后采用“治疗和延长”(treat and extend，T

amp;E)方案，而非“按需治疗” (pro re nata，PRN)方案；（5）对于抗VEGF负荷治疗三个月后在光学相干断层扫描（optical coherence tomography，OCT）上出现持续性SRF或IRF的患者，建议继续抗VEGF治疗而非停药观察；（6）对于伴有新鲜大量视网膜出血且累及黄斑区的PCV患者，建议进行玻璃体切除术联合玻璃体腔内注射组织纤溶酶原激活剂及气体填充，而非抗VEGF单药治疗。

结论

本指南共形成6条推荐意见，以支持PCV患者的最佳治疗选择。

Abstract

Background

In mainland China

patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED)

extensive subretinal or vitreous hemorrhages

and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.

Methods

A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes

regarding opinions on inactive PCV

choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy

photodynamic therapy (PDT) monotherapy or combined therapy

patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF

and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews

which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations

Assessment

Development

and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations.

Results

The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV

we suggest observation over treatment. (2) For treatment-na

#x000ef;ve PCV patients

we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3)

For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment

we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy

we suggest the treat and extend (T

amp;E) regimen rather than the

pro re nata

(PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments

we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula

we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy.

Conclusions

Six evidence-based recommendations support optimal care for PCV patients’ management.

关键词

Keywords

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