玻璃体腔注射康柏西普治疗糖皮质激素治疗无效的Ⅱ型视盘血管炎继发黄斑水肿的疗效观察

Intravitreal injection of Conbercept for macular edema secondary to type Ⅱoptic disc vasculitis

目的探讨玻璃体腔注射康柏西普眼用注射液治疗Ⅱ型视盘血管炎继发黄斑水肿的疗效。方法收集2014年1月至2015年7月在山东省鲁南眼科医院眼底病科就诊的Ⅱ型视盘血管炎合并黄斑水肿的患者16例（16只眼）。其中,男性10例（10只眼）,女性6例（6只眼）。全部患者均予一次玻璃体腔注射康柏西普眼用注射液治疗,随访3~6个月。治疗前后均行视力、裂隙灯显微镜联合前置镜、荧光素眼底血管造影（FFA）及光学相干断层扫描（OCT）检查。采用t检验的方法,比较治疗前后的黄斑中心厚度。结果治疗前,患者视力检查结果为：〈0.1者3例（3只眼）,≥0.1且〈0.2者5例（5只眼）,≥0.2且〈0.3者5例（5只眼）,≥0.3者3例（3只眼）。眼底检查结果为：患者均出现不同程度的视盘水肿,边界模糊,视网膜静脉迂曲扩张,神经纤维层火焰状出血,黄斑弥漫性水肿。OCT检查结果：患者视网膜黄斑区中心部厚度为589~1 098μm,平均为（864.39±58.17）μm。FFA检查显示患者视网膜静脉循环时间明显延长,静脉主干沿途明显荧光着染,黄斑部荧光积存。治疗后,患者视力均有提高。视力提高〉3行者15例（15只眼）,占93.75%。其中,男性10例（10只眼）,女性5例（5只眼）;视力提高1~3行者1例（1只眼）,为女性患者,占6.25%。总有效率为100%。眼底检查结果：全部患者视盘水肿减轻或消退,出血大部分或全部吸收,黄斑水肿减轻或消退。FFA检查结果：所有患者视网膜出血减少,荧光素渗漏减少。OCT检查结果：全部患者视网膜黄斑区中心部厚度（CRT）与治疗前相比,均有显著降低,平均厚度为（263.69±87.28）μm。经t检验,差异有统计学意义（t=8.350,P〈0.05）。随访期间无黄斑水肿复发。结论应用康柏西普眼用注射液玻璃体腔注射治疗Ⅱ型视盘血管炎继发的黄斑水肿,具有注射次数少、可快速改善视功能及作用稳定的优势,值得临床推广应用。

Objective To observe the clinical effects of intravitreal injection of conbercept for macular edema secondary to type Ⅱ optic disc vaseulitis. Methods 16 eyes of 16 cases diagnosed as macular edema secondary to type Ⅱ optic disc vasculitis, which deteriorated through glucocorticoid treatment, from January 2014 to July 2015. the visual acuity examination, slit lamp examination, funduscopes examination, fluorescein fundus angiography and optical coherence tomography were performed. The follow-up is 3-6 months. Preoperative and postoperative macular thickness comparison, using the method of t-test. Results The visual acuity before treatment 〈0. 1 in 3 cases （3 eyes）, ≥0. 1 and 〈0. 2 in 5 cases （5 eyes） , ≥0.2 and 〈0.3 in 5 cases （5 eyes） , ≥0.3 in 3 cases （3 eyes）. Extensive superficial retinal hemorrhage, macular and optic nerve edema. Central retinal thickness is 589-1098 （864.39±58.17）pLm. Hyperfluorescence of retinal vein and optic nerve. After treatment ,the visual acuity of 15 eyes improved 3 or above 3 lines, and 10 of them are male the rest is female,the percentage among all the patients is 93.75 % , 1 eye of a female improved 1 line to blow 3 lines. Compared with preoperation ,fluorescein fundus augiography indicated leakage of retina was alleviated obviously. The postoperative average thickness of macular central fovea was （ 263. 69 ＋ 87. 28 ） μm. The postoperative thickness of macular central fovea was reduced significantly compared with preoperation. The difference was statistically significant （t = 8. 350 ,P〈0.05 ） , In the follow-up, no recrudescence of Macular edema was found. Conclusion Intravitreal injection of conbercept for macular edema secondary to type Ⅱ optic disc vasculitis can improve visual function rapidly and steadily with high safety and good tolerance.