玻璃体腔注射Ranibizumab联合视网膜激光治疗视网膜静脉阻塞继发黄斑水肿的临床观察

The clinical observation on intravitreous injection of Ranibizumab combined with laser photocoagulation for macular edema secondary to retinal vein occlusion

目的评估玻璃体腔注射Ranibizumab联合视网膜光凝治疗视网膜静脉阻塞(RVO)继发黄斑水肿的疗效。方法回顾性分析玻璃体腔注射Ranibizumab联合视网膜光凝治疗RVO继发黄斑水肿患者43例(43只眼)。治疗前和治疗后每月行最佳矫正视力(BCVA)、眼压、眼底检查、FFA检查和频域OCT检查。对比分析治疗前后患者BCVA及黄斑中心视网膜厚度(CMT)的改变。治疗后视力与治疗前视力、CMT行相关性分析。结果治疗6个月,BRVO组、CRVO组log MAR BCVA分别为(0.65±0.36)、(0.57±0.50),与治疗前比较,差异均有统计学意义(t=2.1436、2.8690;均P<0.05)。治疗6个月,CMT分别为(335.82±111.65)μm、(295.47±83.74)μm,与治疗前比较,差异均有统计学意义(t=12.4221、7.4170;均P<0.05)。CRVO组、BRVO组治疗后6个月的BCVA与治疗前BCVA有一定明显相关性(r=0.5410、0.5356;P=0.0373、0.0033),但与治疗前CMT无明显相关性(r=0.2317、-0.0655;P=0.1081、0.7404)。整个治疗及随访中所有患者均未见与注射及药物有关的眼部和全身不良反应。结论玻璃体腔注射Ranibizumab联合视网膜光凝治疗RVO继发黄斑水肿安全有效。

Objective To evaluate the efficacy and safety of intravitreous Ranibizumab combined with laser photocoagulation on macular edema secondary to retinal vein occlusion（ RVO）. Methods A retrospective observation about 43patients（ 43 eyes） with macular edema secondary to RVO received intravitreal injection of Ranibizumab combined with laser photocoagulation. Best corrected visual acuity（ BCVA）,fundus photography and optical coherence tomography examinations were committed before injection and every month after injection. Comparative analysis the changes in BCVA and central macular retinal thickness（ CMT） between before and after treatment. Spearman correlation coefficient was used to measure the strength of correlation between BCVA and anatomic changes. Results At 6 months,the average BCVA was improved to（ 0. 65 ± 0. 36） and（ 0. 57 ± 0. 50） respectively in BRVO and CRVO group,which was significantly better than pre-treatment（ t = 2. 1436,2. 8690; P〈0. 05）. The average CMT was（ 335. 82 ± 111. 65） μm,（ 295. 47 ± 83. 74） μm in BRVO and CRVO group,significantly lower than pre-treatment（ t = 12. 4221,7. 4170; P〈0. 05）. The BCVA at 6months post-treated was correlated to BCVA pre-treatment（ r = 0. 5410,0. 5356; P = 0. 0373,0. 0033）,but not correlated to the CMT（ r = 0. 2317,- 0. 0655; P = 0. 1081,0. 7404）. During treatment and follow-up,all the patients showed no injection and drug-related ocular and systemic adverse reactions. Conclusion Intravitreal injection of Ranibizumab is safe and effective for macular edema caused by RVO in the short term.