玻璃体腔注射曲安奈德与Bevacizumab治疗视网膜静脉阻塞性黄斑水肿疗效比较

Intravitreal triamcinolone versus bevacizumab for the treatment ofmacular edema in retinal vein occlusion

目的比较玻璃体腔注射曲安奈德（TA）与抗血管内皮生长因子单克隆抗体（Bevacizumab）治疗视网膜静脉阻塞性黄斑水肿（RVOME）的临床疗效。方法共116例眼科常规检查以及荧光素眼底血管造影（FFA）和光学相干断层扫描（OCT）检查确诊的RVOME患者的116只眼纳入观察。患者被分成两组进行玻璃体腔注射TA（4mg，0．1ml）或Bevacizumab（1．25mg，0．05ml）治疗。TA组75例，Bevacizumab组41例，两组在术前年龄、病程、最佳矫正视力（BCVA）、中心视网膜厚度（CMT）方面均无显著差异。比较治疗前和治疗后4、8、12周两组间以及各组内部的BCVA、CMT的改变。结果视力方面，与基线比较，TA组治疗后4周（P=-0．ooo）、8周（P=O．ooo）、12周（P=0.000）时均有显著提高；Bevacizumab组治疗后4周（P=0．000）、8周（p=0.000）时显著提高，12周时有所回落（P=0．074）。CMT方面，与基线比较，TA组治疗后4周（P=0．000）、8周（p=0．000）、12周（P=0．004）时，均有显著降低；Bevacizumab组治疗后4周（P=0．003）、8周（P=0．000）时显著降低，12周（P=0．205）时无显著差异。两组间比较，视力在4周（p=0．985）、8周（P=0．989）、12周（P=0．306）时均无显著差异；CMT在4周（P=0．075）、8周（P=0．453）、12周（P=0．583）时均无显著差异。治疗后眼压明显升高仅见于TA组。结论玻璃体腔注射TA或bevacizumab治疗RVOME均能明显改善视力，减轻黄斑水肿。此结果还需大样本、多中心的临床随机对照研究。

Objective To compare the efficiency of intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment ofmacular edema in retinal vein occlusion. Methods One hundred and sixteen eyes of 116 patients with macular edema of retinal vein occlusion were diagnosed by examination of regular inspection, fundus fluorescein angiography （FFA） and optic coherence tomography （OCT）. There were 75 patients in TA group and 41 patients in bevacizumab group. One hundred and sixteen patients received intravitreal injection of either 4mg/0.1ml of triamcinolone acetonide or 1.25mg/0.05ml ofbevacizumab. There were no significant differences between the two groups with regards to patients＇ age, duration of disease, best-corrected visual acuity （BCVA）, central macular thickness （CMT） at baseline. Comprehensive ophthalmic evaluation was performed at baseline and at weeks 4, 8 and 12 after treatment. Main outcome measures included CMT measured with OCT and BCVA. Results Separate within-group analysis of showed significant improvement in BCVA from baseline in TA group at weeks 4 （P=-0.000）,8 （P=0.000） ,12 （P=0.000）, and at weeks 4 （P=-0.000）, 8 （P=0.000） in bevacizumab group. The results showed significant reduction in CMT in TA group at weeks 4（P=0.000）, 8（P=0.000）, 12（P=0.004）, and at weeks 4（P=0.003）, 8（P=-0.000） in bevacizumab group. But no significant interaction between groups were observed for BCVA at weeks 4（P=0.985 ）, 8（P=0.989）, 12（P=-0.306） and for CMT at weeks 4（P=-0.075）, 8（P=0.453）, 12（P=0.583）. There was a significant increase in IOP in the TA group when compared with the bevacizumab group. Conclusion The result in our observation showed that intravitreal injection of either triamcinolone acetonide or bevacizumab was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with retinal vein occlusion. A randomly controlled multi-center clinical trial is necessary.