雷珠单抗治疗视网膜分支静脉阻塞合并黄斑水肿的多焦视网膜电图改变

Multifocal electroretinogram assessments following intravitreal macular edema secondary to branch retinal vein occlusion

目的对比玻璃体腔内注射雷珠单抗治疗视网膜分支静脉阻塞（BRVO）合并黄斑水肿（ME）前后多焦视网膜电图（mfEGR）和光学相干断层扫描（OCT）的变化，探讨该治疗方法的有效性。方法临床回顾性系列研究。将2014年9月至2015年5月在南京医科大学第一附属医院确诊为BRVO合并ME的患者14例（14只眼）纳入研究。所有患眼给予玻璃体腔内注射雷珠单抗治疗。分别于治疗前、治疗后1月、3月记录最佳矫正视力（BCVA），并行mfERG和OCT检查。对比分析治疗前后BCVA、黄斑中心凹厚度（CMT）及mfERG的变化情况。结果治疗前BCVA为0.115±0.062，治疗3个月后增加至0.290±0.089，两者差异具有统计学意义（t=4.874，P〈0.05）。治疗前平均CMT值为（482.00±136.86）μm，治疗1月及3月后分别减至（410.22±135.43）μm和（306.44±73.55）μm，与治疗前相比差异均具有统计学意义（t=3.562、2.917，P〈0.05）。治疗后1月及3月，mfERG 1环P1波的振幅密度显著提高，隐含期缩短，差异具有统计学意义（P〈0.05）。病变区域P1波及N1波的振幅密度和治疗前相比均显著提高，隐含期缩短，差异具有统计学意义（P〈0.05）。结论玻璃体腔注射雷珠单抗可以有效提高BRVO合并ME患者的视力，减轻黄斑水肿，改善黄斑及病变区域视网膜的功能。

Objective To evaluate the functional and structural changes after intravitreal ranibizumab injection in patients with macular edema （ME） due to branch retinal vein occlusion （BRVO） using multifocal electroretinogram （mfERG） and optical coherence tomography （OCT）. Methods Fourteen patients （14 eyes） with ME secondary to BRVO received intravitreal ranibizumab （0.5mg） injection from September 2014 to May 2015. OCT, mfERG and BCVA were measured at baseline, 1 and 3 months after treatment. The changes of BCVA, CMT, amplitude density and latency of P1 and N1 waves were observed. Results Patients had mean BCVA of （0.115±0.062） at baseline, which improved significantly to （0.290±0.089） after 3 months （t =4.874, P 〈0.05）. The mean CMT before treatment was （482.00±136.86）μm and reduced significantly to （410.22±135.43）μm and （306.44±73.55） μm after 1 and 3 months respectively （t =3.562, 2.917, P 〈0.05）. The amplitude densities of P1 wave in ring 1 after injection were significantly increased, and the latencies were decreased （P 〈 0.05）. In affected areas, the amplitude densities of P1 and N1 waves were increased dramatically, and the latencies were decreased （P 〈0.05）. Conclusions Intravitreal ranibizumab injection for ME secondary to BRVO can obtain a better visual acuity and reduce the CMT, at the same time, improve the retinal function of macular and affected area.