玻璃体腔注射雷珠单抗联合激光光凝治疗BRVO合并黄斑水肿

Observation on intravitreal injection of ranibizumab combined with laser photocoagulation for the treatment of macular edema in BRVO

目的:观察玻璃体腔注射雷珠单抗联合激光光凝治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)合并黄斑水肿的疗效和安全性。方法:据荧光素眼底血管造影(FFA)对BRVO合并黄斑水肿患者30例30眼随机分为3组:第1组(10眼)单纯行黄斑区格栅样光凝;第2组(10眼)玻璃体腔注射1次雷珠单抗0.05mL/0.5mg,7d后行黄斑区格栅样光凝;第3组(10眼)玻璃体腔连续注射3次雷珠单抗0.05mL/0.5mg,间隔1mo,第1次注射7d后行黄斑区格栅样光凝。随访6mo,观察最佳矫正视力及OCT检查(干涉光断层扫描仪检查)黄斑中央厚度。结果:患者6mo后视力显著提高,1组平均提高11个字母,2组提高17个字母,3组提高18个字母。OCT显示1组黄斑中央厚度平均降低208.7μm,2组降低312.9μm,3组降低326.8μm。1组中视力提高3行以上1例(10%),2组有3例(30%),3组有4例(40%)。结论:联合治疗明显优于单独激光治疗,雷珠单抗1次玻璃体腔内注射联合黄斑区格栅样激光光凝术治疗BRVO并黄斑水肿安全有效。

AIM： To observe the safety and efficacy of intravitreal injection of ranibizumab combined with laser photocoagulation for the treatment of macular edema in branch retinal vein occlusion （ BRVO） . METHODS： According to fundus fluorescein angiography （ FFA ） , 30 eyes of 30 patients with BRVO were randomized into three groups： group 1 （ 10 eyes ） received grid laser treatment alone, group 2 received a single dose of intravitreal injection of ranibizumab （0.05mL/0.5mg） followed by grid laser treatment on 7d following injection, while group 3 （ 10 eyes ） received three loading doses of intravitreal ranibizumab with 0.05mL/0.5mg for three times.At 1mo interval, grid laser treatment was performed after 7d of the 1st injection.After 6mo follow-up, the best-corrected visual acuity and optical coherence tomography （ OCT ） and central macular thickness were observed. RESULTS：After 6mo, the visual acuity of patients were improved significantly.There was an average increase of 11 letters, 17 letters and 18 letters in group 1, 2, and 3, respectively, with the average decrease in OCT being 208.7μm, 312.9μm and 326.8μm, respectively, in these groups.Gain in visual acuity more than 3 lines was 1 case （ 10%） in group 1.There were 3 cases （ 30%） in group 2 and 4 cases （40%） in group 3. CONCLUSION：Combined therapy is better than laser therapy alone. Single dose of intravitreal ranibizumab with grid laser for macular edema in BRVO seems to be effective.