雷珠单抗联合格栅样光凝治疗视网膜分支静脉阻塞引起的黄斑水肿疗效观察

Comparison of clinical efficacy of intravitreal ranibizumab with and without grid laser photocogagulation for macular edema secondary to branch retinal vein occlusion

目的评估雷珠单抗玻璃体内注射(IVR)与IVR联合格栅样光凝(GLP)治疗视网膜分支静脉阻塞(BRVO)引起的黄斑水肿(ME)的近期疗效和安全性。方法 28例(28只眼)继发于BRVO的ME患者,随机分成两组:一组单纯行雷珠单抗玻璃体内注射,一组于注射后2周行GLP。治疗后1、2、3、4、5、6个月随访视力和黄斑厚度,评估疗效。结果 6个月后,与基线相比,IVR组平均最佳矫正视力(BCVA)提高(9.0±2.6)个ETDRS字母;IVR+GLP组平均BCVA提高(12.3±3.2)个ETDRS字母,差异有统计学意义(P分别为0.004,0.013);IVR组黄斑厚度(CMT)减少(179.4±20.8)μm,IVR+GLP组CMT减少(202.7±15.9)μm,差异有统计学意义(P=0.0001);两组间BCVA和CMT均无统计学差异(P﹥0.05);IVR组注射次数(3.2±1.1)明显高于IVR+GLP组(1.9±1.0,P=0.002);两组均未见严重副作用。结论 IVR和IVR+GLP均能有效提高ME患者视力,减轻黄斑水肿,疗效无统计学差异;联合GLP治疗能减少雷珠单抗的注射次数,因而更经济、适用。

Objective To compare the short-term efficacy and safety of intravitreal ranibizumab （ IVR） or IVR combined with grid laser photocogagulation （ GLP） for macular edema （ ME） secondary to branch retinal vein occlusion （ BRVO） .Methods 28 newly diagnosed patients with ME secondary to BRVO were divided into two groups randomly：one group was treated with IVR and the other group was treated with IVR and GLP.Patients were followed up at 1, 2, 3, 4, 5, 6 months, best corrected visual acuity （BCVA）, changes in BCVA and central macular thickness （CMT） were com-pared in each phase and between groups.Results At month 6, BCVA change from baseline was 9.0 ±2.6 letters in the IVR group （ P =0.004） and 12.3 ±3.2 letters in the IVR＋GLP group （ P =0.013）.Mean CRT changes were 179.4 ±20.8 μm in the IVR group and 202.7 ±15.9 μm in the IVR＋GLP group （ P =0.0001）.There were nostatistically significant differences in BCVA or CRT changes between groups （ P﹥0.05）.The number of intravitreal injections was significantly higher in the IVR group （3.2 ±1.1 injections） than in the IVR＋GLP group （1.9 ±1.0 injections, P =0.002 ） .There were no serious side-effects in both groups.Conclusions IVR or IVR ＋GLP had similar effects on BCVA and CMT in patients with ME secondary to BRVO over a 6-month follow-up period.IVR＋GLP is more affordable and toler-able for patients because of less intravitreal injections.