玻璃体腔注射avastin治疗视网膜分支静脉阻塞继发黄斑水肿疗效观察

The clinical study on intravitreous injection of avastin for macular edema induced by branch retinal vein occlusion

目的评估玻璃体腔注射avastin治疗视网膜分支静脉阻塞（BRVO）继发黄斑水肿的疗效。方法回顾性分析玻璃体腔注射1．25mg（0．05mL）avastin治疗BRVO继发黄斑水肿患者39例（39眼）。治疗前及治疗后1、2、3d，3、6、12周进行最佳矫正视力（BCVA）、眼压、裂隙灯及间接检眼镜检查。治疗前及治疗后6周、12周行光学相干断层扫描（OCT）、彩色眼底照相、荧光素眼底血管造影（FFA）检查。有29、11、2眼分别注射2、3、4次。随访时间3～20个月，平均（4．78±3．91）个月。对比分析治疗前后患者视力及黄斑中心视网膜厚度（CMT）的改变。结果Avastin玻璃体内注射3、6、12周BCVA均提高，差异均有统计学意义（t=-6．039，-6．182，-4．189，P=0．000）。Avastin玻璃体内注射6周、12周时CMT平均值均明显减低（t=8．684，5．019，P=0．000）。治疗前病程≤1个月的患者，治疗后3周，视力平均值比病程〉1个月的患者显著提高（P〈0．05）。治疗前黄斑灌注良好者CMT降低的效果可保持到术后12周，无灌注区组CMT降低的效果保持到术后6周。随访中未见与注射及药物有关的眼部和全身不良反应。结论Avastin玻璃体腔注射治疗BRVO引起的黄斑水肿安全有效，病程短者效果则更好。

Background Branch retinal vein occlusion （BRVO） often leads to macular edema as the result of elevating intravitreal VEGF level, and avastin, a anti-VEGF drug, show a good effectiveness on maeular edema secondary to BRVO. Objective This study attempts to evaluate the clinical efficacy of avastin on maeular edema induced by BRVO. Methods This is a retrospective case-observation study. The clinical data of 39 eyes from 39 patients with macular edema induced by BRVO were included in this analysis. All of the patients received intravitreal injection of 1.25 mg （0. 05 mL）avastin without other any therapy prior to the injection of avastin. This procedure followed the Declaration of Helsinki, and written informed consent was obtained from all the patients before and initial of any management. Clinical indexes included best-corrected visual acuity （BCVA） , slit-lamp examination,intraocular pressure and stereoscopic biomieroscopy examination before injection and 3,6 and 12 weeks after initial injection. Optical coherence tomography （OCT）, fundus photography, fluorescein fundus angiography （FFA） were performed prior to injection and 6,12 weeks after initial injection. The follow-up period was 3 -20 months. Results The mean BCVA was significantly improved at 3,6, 12 weeks after injection in comparison with before injection （ t = - 6. 039, -6. 182, -4. 189,all P = 0. 000）. The mean CMT showed a statistically significantly decline at 6,12 weeks after injection in comparison with before injection （ t = 8. 684,5. 019, all P = 0. 000）. No ocular or systemic adverse events were found after intravitreal injection of avastin during the follow-up duration. The numbers of visual acuity-improved eyes were significantly increased in the patients with disease course ≤ 1 month duration in comparison to ones with the course ≥ 1 month （P 〈 0. 05） in 3 weeks after injection. CMT was obviously decreased in 12 weeks after injection in comparison to before injection between with and without macular perfusion eyes （ P 〈 0.05 ）. Conclusion Intravitreal injection of avastin is safe and effective for macular edema induced by BRVO ,especially the patients with shorter course of disease.