玻璃体腔注射雷珠单抗联合激光治疗视网膜黄斑分支静脉阻塞继发黄斑水肿

Efficacy of intravitreal injection with Ranibizumab combined with laser photocoagulation for macular edema secondary to macular branch retinal vein occlusion

目的:观察玻璃体腔注射雷珠单抗联合激光治疗视网膜黄斑分支静脉阻塞(MBRVO)继发黄斑水肿的临床疗效。方法:回顾性研究。临床确诊为MBRVO继发黄斑水肿的患者33例33眼纳入研究。玻璃体腔注射10mg/mL雷珠单抗0.05mL(含雷珠单抗0.5mg)。治疗后每月复查,复查时发现视力下降和OCT检查发现黄斑水肿复发者再次重复注射雷珠单抗。复查发现出血明显吸收及OCT复查发现黄斑水肿明显消退者,在原水肿部位进行视网膜光凝。观察治疗前与治疗后6mo最佳矫正视力、黄斑中心凹视网膜厚度(central macular thickness,CMT)、多焦视网膜电生理检查P1波的振幅密度及潜伏期的变化。结果:治疗前BCVA经LogM AR转换后为0.68±0.35,治疗后6mo为0.34±0.23,与治疗前相比差异有统计学意义(P<0.01)。其中,21眼(64%)BCVA提高2行及以上者,9眼(27%)维持于就诊时水平,无视力下降者。治疗前平均CMT为487.30±63.58μm,治疗后6mo CMT降为238.84±52.66μm,与治疗前相比差异有统计学意义(P<0.01)。治疗后6mo患者1环、2环、3环的P1波振幅密度均有提高,与治疗前相比差异均有统计学意义(P<0.01);治疗后6mo患者1环、2环、3环的P1波潜伏期均有缩短,与治疗前相比差异均有统计学意义(P<0.05)。玻璃体腔注射后2眼出现结膜下出血。结论:雷珠单抗联合局部视网膜光凝治疗视网膜黄斑分支静脉阻塞继发黄斑水肿可有效减轻黄斑水肿,显著提高患者视力,改善视功能。

AIM： To observe the efficacy of intravitreal injection with ranibizumab combined with laser photocoagulation for macular edema （ ME ） secondary to macular branch retinal vein occlusion（ MBRVO） . METHODS：A retrospective analysis included 33 patients （33 eyes） with ME secondary to MBRVO were taken. All patients received intravitreal injection of 0. 5mg ranibizumab （ 0. 05ml ） at first visit. The continue PRN treatment and laser photocoagulation were based on the visual acuity changes and optical coherence tomography findings. The changes of best corrected visual acuity （ BCVA） , central macular thickness（ CMT） , and amplitude density and latency of P1 wave in mfERG were observed before treatment and 6mo after treatment. RESULTS： Before the treatment, logMAR was 0. 68±0.35, 6mo after treatment was 0. 34±0. 23, BCVA was improved obviously （ P 〈 0. 01 ）, BCVA in 21 patients （ 63.64%） were improved in two rows among all the patients. CMT before treatment was（487. 30±63. 58） μm, after treatment was（238. 84±52. 66） μm（P〈0. 01）. The amplitude densities of P1 wave in ring 1, ring 2 and ring 3 after treatment were significantly increased（all P〈0. 01）, and the latencies were decrease （ all P 〈 0. 05 ）. The conjunctival hemorrhage was observed in 2 eyes after treatment. CONCLUSION： Intravitreal injection with ranibizumab combined with laser photocoagulation for ME secondary to MBRVO can reduce the CMT and improve visual function.