视网膜静脉阻塞性黄斑水肿药物治疗后的眼屈光度改变

Refractive changes after pharmacologic resolution of macular edema induced by retinal vein occlusion

目的探讨视网膜静脉阻塞性黄斑水肿经药物治疗消退后的屈光度改变。设计回顾性病例系列。研究对象46例46眼视网膜静脉阻塞性黄斑水肿患者,初诊时无黄斑脱离组19眼及伴有黄斑脱离组27眼。方法患者经玻璃体腔注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物(康柏西普或雷珠单抗)或后筋膜下注射曲安奈德(triamcinolone,TA)后,黄斑水肿消退或近乎消退定义为终末随诊点。分析两组基线与终末随诊的等效球镜度(spherical equivalent refraction,SE)差异。主要指标SE。结果基线不伴有黄斑脱离组,基线时SE(0.38±1.71)D,终末随诊点SE(0.32±1.68)D,SE差值绝对值平均值(0.31±0.32)D,SE改变无统计学意义(t=0.577,P=0.571)。基线伴有黄斑脱离组,基线时SE(0.79±1.25)D,终末随诊点SE(0.26±1.15)D,SE差值绝对值平均值(0.88±0.81)D,SE改变有统计学意义(t=2.541,P=0.017)。结论对于不伴有黄斑脱离的视网膜静脉阻塞性黄斑水肿患者不必延迟屈光矫正。

Objective To determine the change of refractive power caused by treatment in patients with macular edema induced by retinal vein occlusion. Design Retrospective case series. Participants Forty six eyes of 46 consecutive patients with clinically sig- nificant macular edema with retinal vein occlusion. The subjects were divided into two groups： macular edema without macular detach- ment group and macular edema with macular detachment group. Methods All patients received intravitreal anti-vascular endothelial growth factor （VEGF） or posterior Tenon subtenon injection of triamcinolone （TA）. The change in refraction （spherical equivalent refrac- tion, SE） between baseline and the final visit without macular edema or the central subfield thickness （CST） measured by optical coher- ence tomography reached the thinnest level was analyzed in the two groups respectively. Main Outcome Measures SE. Results In macular edema without macular detachment group, the baseline SE, final visit SE and the mean absolute value of SE change was 0.38± 1.71 D , 0.32±1.68 D , 0.31±0.32 D, respectively （t=0.577, P=0.571）. In macular edema with macular detachment group, the baseline SE, final visit SE and the mean absolute value of SE change was 0.79±1.25 D, 0.26±1.15 D , 0.88±0.81 D, respectively （t=2.541, P= 0.017）. Conclusions Appropriate spectacle correction can be prescribed to patients with macular edema but without macular detach- ment any time during ongoing therapy using intravitreal anti-VEGF or posterior Tenon subtenon injection of TA.