雷珠单抗和曲安奈德治疗视网膜中央静脉阻塞的黄斑水肿的配对病例研究

Comparison of ranibizumab and triamcinolone for treatment of macular edema secondary to central retinal vein occlusion

目的:研究玻璃体腔注射曲安奈德(triamcinolone acetonide,TA)和雷珠单抗(Lucentis)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)的黄斑水肿的疗效。方法:配对病例对照研究。将2013年1月至2015年6月,在我院因CRVO并发黄斑水肿而接受玻璃体腔注射TA或Lucentis的患者,根据患者基线水平的最佳矫正视力(best-corrected visual acuity,BCVA)(log MAR视力)和黄斑中心厚度(central macular thickness,CMT)将两组患者进行配对,选出12对患者,主要的观察指标为随访1年时两组患者的BCVA和CMT。结果:TA组患者的BCVA由基线时的0.78±0.12提高到0.55±0.24(P=0.005),CMT由基线时的(598.92±192.67)μm减少到(258.28±75.38)μm(P=0.002)。Lucentis组患者的BCVA由基线时的0.78±0.11提高到0.48±0.21(P=0.002),CMT由基线时的(591.75±181.68)μm减少到(281.17±63.08)μm(P=0.002)。TA组和Lucentis组患者基线及最终的BCVA和CMT直接均无显著差异。TA组的平均注药次数为(2.4±0.9)次,Lucentis组为(4.0±1.6)次,两组有统计学差异(P=0.012)。结论:玻璃体腔注射TA或Lucentis均能减轻CRVO所致的黄斑水肿并提高视力,两者的疗效并无显著差异。TA的平均注射次数比Lucentis组少,但是TA更容易引起眼压升高。应该根据患者的综合情况制定个性化的治疗方案。

Objective： To compare the efficacy of intravitreal injections of triamcinolone acetonide （TA） and that of ranibizumab for macular edema secondary to central retinal vein occlusion （CRVO）. Methods： In a retrospective assessment 12 TA-treated patients and 12 ranibizumab-treated ones with macular edema after CRVO were pairmatched according to initial best-corrected visual acuity （BCVA） and central macular thickness （CMT）. BCVA and CMT were the main endpoints. Results： The initial BCVA of 0.78±0.12 increased significantly to 0.55±0.24 in the TA-treated patients （P=0.005）. And the initial CMT of （598.92±192.67） μm decreased significantly to （258.28±75.38） μm （P=0.002）. In the ranibizumab-treated patients, the initial BCVA of 0.78±0.11 increased significantly to 0.48±0.21 （P=0.002） and the initial CMT of （591.75±181.68） μm decreased significantly to （281.17±63.08） μm （P=0.002）. There was no significance between the initial and final BCVA and CMT of TA- treated patients and ranibizumab-treated patients. Conclusion： Both treatments decreased the CMT and induced an improvement in BCVA from baseline.