光凝前雷珠单抗玻璃体内注射对CNV患者黄斑区视网膜及视功能的影响

Effects of ranibizumab intravitreal injection before photocoagulation on macular retina and visual function in patients with CNV

目的探讨光凝前雷珠单抗玻璃体内注射对脉络膜新生血管（choroidalneovascularization，CNV）患者黄斑区视网膜及视功能的影响。方法选取2012年1月至2014年1月我院收治的CNV患者100例（100眼），按治疗方式的不同将患者分为观察组、对照组，观察组给予雷珠单抗玻璃体内注射后行激光光凝，对照组给予妥布霉素地塞米松滴眼液及抗生素滴眼液滴眼后行激光光凝。术后随访3—6个月，平均4个月，观察两组患者CNV变化及临床疗效，采用国际标准视力表检查患者裸眼视力，同时采用OCT测量患者治疗前后黄斑区视网膜厚度。结果观察组、对照组的总有效率分别为86．0％、54．0％，差异有统计学意义（X2=13．78，P〈0．05）。观察组、对照组患者治疗前黄斑区视网膜厚度分别为（351．2±10．3）μm、（351．3±10．2）μm，治疗后分别为（150．4±7．8）μm、（252．3±9．6）μm，两组治疗后黄斑区视网膜厚度均低于治疗前，差异均有统计学意义（t=109．90、49．98，均为P〈0．01）；但观察组治疗后黄斑区视网膜厚度下降幅度显著优于对照组，差异具有统计学意义（t=58．25，P〈0．05）。观察组、对照组患者治疗前裸眼视力均为0．2±0．1，治疗后分别为1．0±0．3、0．3±0．3；两组治疗后裸眼视力均高于治疗前，差异均有统计学意义（t=17．89、2．24，均为P〈0．05）；但观察组治疗后裸眼视力显著优于对照组，差异具有统计学意义（t=13．33，P〈0．05）。结论CNV患者光凝前行雷珠单抗玻璃体内注射，视力恢复显著，有助于视功能及视网膜形态的恢复，临床效果确切。

Objective To discuss the effects of ranibizumab intravitreal injection before photocoagulation on macular retina and visual function in patients with choroidal neovascularization（ CNV）. Methods A total of 100 cases of patients with CNV in our hospital from January2012 to January 2014 were chosen,according to the different treatments,they were divided into the observation group and the control group,50 cases in each group,the observation group was treated with intravitreal ranibizumab injection before photocoagulation,the control group with decaesadril and antibiotic eyedroping before photocoagulation,the patients were followed up from 3 months to 6 months after treatment,averaged 4 months,the change of CNV before and after the treatment of two groups and the change of macular retinal thickness and visual acuity change were observed. Results The total clinical efficiency rates of observation group and control group were 6. 0% and 4. 0%,respectively,the differences were statistically significant（ P85 0. 05）. The macular retinal thicknesses before the treatment in the observation group and control group were（ 351. 2 ± 10. 3） μm and（ 351. 3 ± 10. 2） μm,respectively,which after the treatment were（ 150. 4 ± 7. 8） μm and（ 252. 3 ± 9. 6） μm,respectively,there were statistical differences before and after treatment of two groups（ t = 109. 90,49. 98; all P 0. 01）. The decreased degree of macular retinal thicknesses after the treatment in the observation group was better than that in the control group（ t = 58. 25,P〈0. 05）. The uncorrected visual acuity before the treatment in the observation group and control group were all 0. 2 ± 0. 1,which after treatment were 1.0 ± 0. 3,0. 3 ± 0. 3,respectively,there were statistical there were statistical differences before and after treatment of two groups（ t = 17.89,2. 24; all P〈0. 05）. The uncorrected visual acuity after treatment in the observation group was better than that in the control group（ t = 13. 33,P〈0. 05）. Conclusion Ranibizumab intravitreal injection before photocoagulation for patients with CNV can improve the visual acuity obviously,it contributes to the recovery of visual function and retinal morphology,clinical effect is exact.