目的 探讨七叶洋地黄双苷滴眼液联合雷珠单抗注射液治疗渗出型老年性黄斑变性的临床效果。方法 选取2020年8月—2021年7月湖北省中西医结合医院收治的86例（86只眼）渗出型老年性黄斑变性患者，按随机数字表法将86例（86只眼）患者分成对照组和治疗组，每组各43例（各43只眼）。对照组给予玻璃体内注射雷珠单抗注射液，常规消毒铺巾并行表面麻醉后，向患者玻璃体内垂直进针，注射部位在角巩膜缘后3.5 mm处，剂量为0.5 mg/次，1次/月。治疗组在此基础上于眼结膜囊内滴入七叶洋地黄双苷滴眼液，1滴/次，3次/d。连续治疗3个月后观察两组临床疗效。比较治疗前后两组最佳矫正视力、眼底情况[黄斑中心凹厚度（CMT）、眼底渗出面积及出血面积、荧光素眼底血管造影（FFA）荧光渗漏面积]、视网膜中央动脉血流动力学指标[平均血流速度（Vmean）、阻力指数（RI）、收缩期峰值流速与舒张末期流速比值（S/D）]及血清血管内皮生长因子（VEGF）、血小板衍生生长因子（PDGF）、内皮素1（ET-1）和C反应蛋白（CRP）水平。结果 治疗后，治疗组总有效率是90.7%，较对照组的72.1%显著提高（P<0.05）。两组治疗后最佳矫正视力均显著提高，CMT、眼底渗出面积及出血面积、FFA荧光渗漏面积均显著缩小（P<0.05）；但均以治疗组改善更显著（P<0.05）。治疗后，两组视网膜中央动脉V_mean均显著增加，视网膜中央动脉RI、S/D均显著降低（P<0.05）；但均以治疗组改善更显著（P<0.05）。治疗后，两组血清VEGF、PDGF、ET-1和CRP水平均显著低于治疗前（P<0.05）；且治疗后，治疗组血清VEGF、PDGF、ET-1和CRP均显著低于对照组（P<0.05）。结论 七叶洋地黄双苷滴眼液联合雷珠单抗治疗渗出型老年性黄斑变性的总体疗效满意，可安全有效地提高患者视力、促进眼底病理改变的改善及改善眼部血供，并能进一步抑制血清VEGF、PDGF、ET-1和CRP的水平。

Objective To investigate the clinical effect of Esculin and Digitalisglycosides Eye Drops combined with ranibizumab in treatment of exudative age-related macular degeneration. Methods A total of 86 patients (86 eyes) with exudative age-related macular degeneration who were treated in Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine from August 2020 to July 2021 were selected and divided into control group and treatment group with 43 cases in each group (43 eyes in each case) using the random number table method. Patients in the control group were given Ranibizumab Injections. After routine disinfection and surface anesthesia, the injection site was 3.5 mm behind the corneoscleral margin, and the dose was 0.5 mg/time, once monthly. Patients in the treatment group were dropped Esculin and Digitalisglycosides Eye Drops in the conjunctival sac of the eye on the basis of the control group, 1 drop/time, 3 times daily. The clinical efficacy of the two groups was observed after 3 months of continuous treatment. The best corrected visual acuity, fundus conditions[foveal macular thickness (CMT), fundus exudation area and hemorrhage area, fluorescein fundus angiography (FFA) fluorescence leak area], central retinal artery blood flow were compared between the two groups before and after treatment. Fluid dynamics indexes[mean blood flow velocity (V_mean), resistance index (RI), ratio of peak systolic flow velocity to end-diastolic flow velocity (S/D)] and serum vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)), endothelin-1 (ET-1) and C-reactive protein (CRP) levels. Results After treatment, the total effective rate of the treatment group was 90.7%, which was significantly higher than that of the control group (72.1%, P < 0.05). After treatment, the best corrected visual acuity was significantly improved, and the CMT, fundus exudation area and bleeding area, and FFA fluorescence leakage area were significantly reduced in both groups (P < 0.05). However, the improvement was more significant in the treatment group (P < 0.05). After treatment, the V_mean of central retinal artery was significantly increased, but the RI and S/D of central retinal artery were significantly decreased in both groups (P < 0.05). However, the improvement was more significant in the treatment group (P < 0.05). After treatment, the serum levels of VEGF, PDGF, ET-1, and CRP in the two groups were significantly lower than those before treatment (P < 0.05). After treatment, serum VEGF, PDGF, ET-1, and CRP in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Esculin and Digitalisglycosides Eye Drops combined with ranibizumab has satisfactory overall curative effect in treatment of exudative age-related macular degeneration, and can safely and effectively improve the visual acuity of patients, and promote the improvement of fundus pathological changes and improve ocular blood supply, which can further inhibit the levels of serum VEGF, PDGF, ET-1 and CRP.

R988.1

湖北省科技计划项目（20191016）