葡萄膜炎性黄斑水肿药物治疗的临床疗效

Clinical effect of drug treatment for uveitic macular edema

目的探讨曲安奈德玻璃体腔注射(IVTA)或雷珠单抗玻璃体腔注射(IVR)治疗葡萄膜炎性黄斑水肿(UME)的临床疗效。方法我院眼科确诊为UME患者51例(61眼),26例(31眼)行IVTA治疗,25例30眼行IVR治疗,术前及术后2周、1个月、3个月、6个月行最佳矫正视力(BCVA)、眼压、黄斑中心凹厚度(CMT)、荧光素眼底血管造影(FFA)等检查并分析。结果 IVTA组与IVR组术后1个月、3个月BCVA及CMT明显改善,与治疗前对比差异均具有统计学意义(P值均<0.05)。术后6个月IVTA组87.1%患眼视力显著提高,45.2%患眼黄斑水肿消退;IVR组83.3%患眼视力显著提高,33.3%患眼黄斑水肿消退。组间BCVA对比,术后2周、1个月、3个月差异均无统计学意义(P值均>0.05);CMT变化差值对比,术后2周、1个月、3个月差异均具有统计学意义(P值均<0.05)。IVTA组14眼术前FFA可见轻度视盘渗漏,随访6个月后9眼黄斑水肿消退,视力明显提高;IVR组15眼术前FFA无明显视盘渗漏,6个月后10眼黄斑水肿消退,视力明显提高。2组均未出现严重并发症。结论曲安奈德或雷珠单抗治疗葡萄膜炎性黄斑水肿均有明显疗效,可提高视力,减轻黄斑水肿。对于伴有视盘渗漏者,曲安奈德疗效更显著。对于无明显视盘渗漏者,雷珠单抗疗效确切。

Objective To explore the clinical effect of intravitreal injection of triamcinolone acetonide （IVTA） or intravitreal injection of ranibizumab （IVR） for the treatment of uveitic macular edema. Methods There were 61 eyes of 51 patients diagnosed noninfectious uveitic macular edema. Thirty-one eyes of 26 patients received IVTA and other eyes received IVR. The best corrected visual acuity（BCVA） , intraocular pressure （IOP）, fluorescein fundus angiography （FFA） and central macular thickness（CMT） were analyzed. Results The BCVA and CMT of the two groups were both improved after following up for 1 month and 3 months, which had statistically significant differences respectively compared with before injections （ P 〈 0. 05 ）. After 6 months＇ follow-up, the BCVA was achieved in 87.1% in IVTA group,and 83.3% in IVR group. The percent of disappearance of macular edema was 45.2% and 33.3% respectively. There were no significant differences in the mean value of BCVA between the two groups after 2 weeks, 1 month and 3 months after injection （ P 〉 0.05 ）. While the CMT changes were significant between the two groups after 2 weeks, 1 month and 3 months（P 〈0.05）. In IVTA group, 14 eyes had a leakage of optic disk showed by FFA. The macular edema of 9 eyes was extinct, and the BCVA was improved after 6 months. In IVR group, 15 eyes had no leakage of the optic disk showed by FFA. The macular edema of 10 eyes disappeared, and BCVA was improved after 6 months. No serious complications was seen in both groups. Conclusions Both IVTA and IVR have obvious effect. They can improve visual acuity and reduce macular edema. Triamcinolone aeetonide seems to be more effective for patients presenting with leakage of the optic disk, whereas in patients only with a macular edema, ranibizumab treatment seems like a good choice. （Chin J Ophthalmol and Otorhinolaryngol,2017 ,17 ：36-39 ,60）