玻璃体腔注射Bevacizumab与曲氨奈德治疗视网膜静脉阻塞继发黄斑水肿比较研究

Comparative Research of Intravitreal Bevacizumab Versus Triamcinolone Treatment for Macular Edema in Retinal Vein Occlusion

目的:比较玻璃体腔注射抗血管内皮生长因子单克隆抗体Bevacizumab与曲安奈德(TA)治疗视网膜静脉阻塞性黄斑水肿的临床疗效。方法:回顾性分析48例眼科常规检查及经荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查均确诊为黄斑水肿,视力≤0.6,黄斑中心凹厚度(CMT)≥250μm的视网膜静脉阻塞性黄斑水肿患者的48只眼纳入观察,两组分别进行玻璃体腔注射Bevacizumab(Be组16例,1.25 mg,0.05 ml)或TA(TA组32例,4 mg,0.1 ml)治疗。比较治疗前和治疗后1,2,3 d及1,2,4,8,12,24周两组及组间的最佳矫正视力(BCVA)改变;治疗前和治疗后1,2,4,8,12,24周两组及组间的CMT、黄斑中心容积(CMV)、黄斑区平均中央厚度(AVG)的改变。结果:Be组在治疗后视力明显提高,术后各时间点均具有显著改变(P<0.05),第8周时视力显著提高(BCVA=0.618 8±0.207 3),术后1周有11例视力提高大于3行,占68.75%。TA组在治疗后视力明显提高,术后各时间点(P=0.000)均具有统计学意义,第4周(BCVA=0.431 9±0.198 9)、8周(BCVA=0.539 1±0.217 7)、12周(BCVA=0.520 3±0.212 5)时视力基本持平,24周(BCVA=0.360 9±0.184 8)时缓慢下降,术后1周有15例视力提高大于3行,占41.67%。CMT方面,较基线比,Be组在治疗后黄斑水肿厚度明显降低,术后各时间点均具有统计学意义(P<0.05),第8周时黄斑水肿程度最低[CMT=(245.437 5±46.740 3)μm]。TA组在治疗后CMT明显降低,术后各时间点(P=0.000)均具有统计学意义。与基线相比,CMV、AVG两组均具有显著改变。各项指标两组间均无统计学差异。BCVA分别与CMT、CMV、AVG呈负相关。治疗后眼压明显升高仅见于TA组。结论:玻璃体腔注射Bevacizumab及TA治疗视网膜静脉阻塞性黄斑水肿均可明显改善视力,减轻黄斑水肿,但两者治疗效果无显著差异。BCVA分别与CMT、CMV、AVG呈负相关,CMV、AVG也可反映治疗效果,但敏感性不及CMT。

Objective： To compare the efficiency of intravitreal injection of bevacizumab or triamcinolone for the treatment of macular edema in retinal vein occlusion.Methods： A total of 48 eyes with macular edema second to retinal vein occlusion were included.All cases were diagnosed by the examinations of regular inspection,fundus fluorescein angiography（FFA） and optic coherence tomography（OCT）,with vision≤0.6 and central macular thickness（CMT） ≥250 μm.Both groups received intravitreal injection of either 1.25 mg/0.05 ml of bevacizumab（Be group,n=16） or 4 mg/0.1 ml of triamcinolone（TA group,n=32）.Best corrected visual acuity（BCVA） were compared between the two groups at baseline and in 1,2,3 days and 1,2,4,8,12,24 weeks after treatment,meanwhile,CMT,CMV,and AVG were also compared at baseline and in 1,2,4,8,12,24 weeks.Results： BCVA of Be group were significantly increased from the first day（P0.01）,and reached to the peak in 8 weeks（BCVA=0.618 8±0.207 3）.There were 11 cases＇ BVCA（68.75%） were increased more than three lines in one week.BCVA of TA group were significantly increased in each time point too（P=0.000）,BCVA in 4（BCVA=0.431 9±0.198 9）,8（BCVA=0.539 1±0.217 7）,12（BCVA=0.520 3±0.212 5） weeks,were similar,but slowly decreased in 24 weeks（BCVA=0.360 9±0.184 8）.There were 15 cases＇ BVCA（41.67%） were increased more than 3 lines in one week.CMT of Be group was significantly decreased in 1,2,4,8,12,and 24 weeks（P0.05）,and dropped to the bottom in 8 weeks（CMT=245.437 5±46.740 3 μm）.CMT of TA group were significantly increased in each time point（P=0.000）.Compared with baseline,the changes of CMV and AVG in both groups were significant.BCVA had negative correlation with CMT,CMV,and AVG,respectively.High IOP were seen only in TA group.Conclusion： Intravitreal injection of bevacizumab or triamcinolone for the treatment of macular edema in retinal vein occlusion could increase BCVA and reduce macular edema instinctively,but the difference was not significant.BCVA has negative correlation with CMT,CMV,and AVG respectively.CMV and AVG also can reveal the effect of treatment,but are less sensitive than CMT.