玻璃体腔注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞继发黄斑水肿的效果

Clinical observation of intravitreal ranibizumab injection combined with grid laser photocoagulation in the treatment of macular edema secondary to branch retinal vein occlusion

目的观察玻璃体腔注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞继发黄斑水肿的疗效及安全性。方法将2014年7月~2015年7月在梅州市人民医院确诊为视网膜分支静脉阻塞继发黄斑水肿的患者32例（32眼）纳入研究,随机将其分为2组：单纯光凝组16眼,行黄斑区格栅样光凝并给予复方血栓通胶囊药物;联合治疗组16眼,先行玻璃体腔内注射雷珠单抗0.05 ml/0.5 mg,同时给予复方血栓通胶囊药物,并于注药1周后行黄斑区格栅样光凝。所有患者均随访6个月,对比分析两组患者治疗前和治疗后1、3、6个月时采用糖尿病视网膜病变早期治疗研究（ETDRS）检查的最佳矫正视力（BCVA）及黄斑区中心凹厚度（CMT）变化情况以及有关眼部和全身不良反应发生情况。结果单纯光凝组治疗前的ETDRS视力平均为（21.8±8.63）个字母,治疗后1、3、6个月的视力分别为（33.5±9.76）、（31.6±9.96）、（30.5±8.83）个字母,与治疗前比较差异有统计学意义（P〈0.05）。联合治疗组治疗前的视力平均为（21.4±9.12）个字母,治疗后1、3、6个月的视力分别为（40.4±10.01）、（39.8±9.91）、（39.6±9.24）个字母,与治疗前比较视力明显提高,差异有统计学意义（P〈0.05）。单纯光凝组治疗前的CMT平均为（549.2±120.4）μm,治疗后1、3、6个月的CMT分别为（290.3±88.6）、（268.9±78.5）、（252.4±66.3）μm,与治疗前比较差异有统计学意义（P〈0.05）。联合治疗组治疗前的CMT平均为（550.6±114.8）μm,治疗后1、3、6个月的CMT分别为（206.2±54.7）、（190.1±53.8）、（180.5±34.6）μm,与治疗前比较CMT明显降低,差异有统计学意义（P〈0.05）。治疗后1、3、6个月联合治疗组视力和CMT均优于单纯光凝组（P〈0.05）。随访过程中未发现有关眼部及全身不良反应。结论玻璃体腔注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞继发黄斑水肿安全有效,可以显著提高视力,联合治疗的疗效明显优于单纯光凝治疗。

Objective To observe the effectiveness and safety of combined therapy of intravitreal ranibizumab with grid laser photocoagulation for macular edema secondary to branch retinal vein occlusion（BRVO）.Methods Thirty-two eyes of 32 patients with macular edema secondary to BRVO in People′ s Hospital of Meizhou City from July 2014 to July2015 were randomized into two groups：laser group（16 eyes） were given grid laser photocoagulation and compound Xueshuantong capsule,combined group（16 eyes） were given a single dose of intravitreal ranibizumab（0.05 ml/0.5 mg）and followed by grid laser photocoagulation after1 week,combined with compound Xueshuantong capsule.Follow-up for 6 months,the changes of best-corrected visual acuity（BCVA） checked bg early treatment diabetic retinopathy study（ETDRS） and central macular thickness（CMT） among before treatment and 1month,3,6 months after theatment were compared in the two groups,the ocular and systemic adverse reactions about treatments were also followed up.Results The BCVA before treatment in the laser group was（21.8 ±8.63） letters,which was significantly improved to（33.5±9.76） letters,（31.6±9.96） letters,（30.5±8.83） letters respectively,at 1 month,3,6 months after treatment（P〈0.05）.The BCVA before treatment in the combined group was（21.4 ±9.12） letters,which was also significantly improved to（40.4±10.01） letters,（39.8±9.91） letters,（39.6±9.24） letters respectively,at 1 month,3,6 months after treatment（P〈0.05）.The CMT before treatment in the laser group was（549.2±120.4） μm,which was significantly reduced to（290.3±88.6）,（268.9±78.5）,（252.4±66.3） μm respectively,at 1 month,3, 6 months after treatment（P〈0.05）.The CMT before treatment in the combined group was（550.6±114.8） μm,which was significantly reduced to（206.2±54.7）,（190.1±53.8）,（180.5±34.6） μm respectively,at 1month,3,6 months after treatment（P〈0.05）.The BCVA was better and the CMT was thinner in the combined group than that in the laser group at 1 month,3,6 months after treatment respectively（P〈0.05）.No ocular or systemic adverse reactions was observed during follow-up period.Conclusion Intravitreal ranibizumab injection combined with grid laser photocoagulation,which can significantly improve vision and is a clinical effective and safe method for macular edema secondary to BRVO.The curative effect of combined treatment is better than that of grid laser photocoagulation alone.