雷珠单抗玻璃体内注射联合视网膜光凝与单独光凝治疗黄斑水肿效果对比

Comparison of clinical efficacy between intravitreal injection of ranibizumab combined with grid laser photocoagulation versus laser photocoagulation alone for macular edema

目的比较雷珠单抗玻璃体内单次注射联合格栅样视网膜激光光凝与单独激光光凝治疗视网膜分支静脉阻塞引起的黄斑水肿的效果对比。方法病程8周以上的视网膜分支静脉阻塞继发黄斑水肿40例（40只眼），随机分为两组：第一组（20只眼）单纯行黄斑区格栅样视网膜激光光凝；第二组（20只眼）玻璃体内注射雷珠单抗1次，然后进行黄斑区格栅样光凝。在治疗后的1、3、6及12个月进行随访，观察最佳矫正视力（BCVA）及黄斑中心区厚度（CMT）变化。结果第一组治疗后1、3、6及12个月，平均BCVA（10gMAR）分别与基线视力比较差异均无统计学意义（t=0．105，0．445，0．944，0．564，P〉0．05）；第二组治疗后分别与基线视力比较差异有统计学意义（t=4．684，4．675，3．823，3．616，P〈0．05）。治疗后12个月BCVA与治疗前比较，BCVA（10gMAR）提高0．3以上者：第1组有5例（25．00％），第2组13例（65．00％）（X2=6．46，P=0．01）。两组之间CMT比较，在1、3、6及12个月差异均有统计学意义（t=7．057，5．505，3．070，2．605，P〈0．05）。在随访12个月时，第1组CMT下降（230．4±107．6）斗m，第2组下降（336．2±167．5）μm。结论玻璃体内单次注射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安全有效，较单独格栅样光凝治疗取得效果更好。

Abstract] Objective To compare the efficacy of combination therapy of single intravitreal injection of ranibizumab with grid laser photocoagulation and only laser photocoagulation for the treatment of macular edema due to branch retinal vein occlusion （BRVO）. Methods Forty eyes of 40 patients with BRVO of at least 8 weeks duration were divided randomly into two groups. Group 1 with 20 eyes received grid laser photocoagulation alone; Group 2 with 20 eyes received a single dose of intravitreal ranibizumab followed by grid laser photocoagulation. Outcomes at 1,3,6 and 12 months follow-up were reported. Data were collected on best corrected visual acuity （BCVA）, and central macular thickness （CMT）. Results BCVA in group 1 compared with baseline vision showed no statistically significant difference at 1,3,6 and 12 months after treatment （ t = 0. 105,0. 445,0. 944,0. 564, P 〉 0. 05 ）. However, BCVA in group 2 compared with baseline showed statistically significant difference at all the follow-up time （t =4. 684,4. 675,3. 823,3. 616, P 〈 0.05 ）. At the 12-month follow-up, vision improvement≥ 0.3 logMAR was observed in 5 （25 % ,5/20） eyes in group 1, while 13 eyes （65%） in group 2 （X2 = 6.46, P = 0.01 ）. At 1, 3, 6 and 12 months, there were statistically significant differences in the mean CMT of two groups （P 〈 0.05 ）. At 12 months, the CMT of two groups were decreased by （230.4 ＋ 107.6）μm in Group 1, （336.2 ＋ 167.5）μm in Group 2 from baseline respectively. Conclusion Combination therapy of single intravitreal injection of ranibizumab withgrid laser photocoagulation for the treatment of macular edema due to BRVO was effective and safe, which would produce better results than grid laser photocoagulation alone.