不同方法治疗视网膜分支静脉阻塞继发黄斑水肿的疗效

Efficacy of intravitreal ranibizumab or Conbercept combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion

目的:观察玻璃体腔注射康柏西普与雷珠单抗联合黄斑区格栅样激光光凝(macular laser grid photocoagulation,MLG)治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿(macular edema,ME)的疗效。方法:按照计算机产生随机数将BRVO继发ME患者120例120眼分为3组,各40例40眼,A组:单纯行MLG;B组:玻璃体腔注射雷珠单抗(0.05mL/0.5mg)1wk后给予MLG治疗;C组:玻璃体腔注射康柏西普(0.05mL/0.5mg)1wk后给予MLG治疗。三组治疗后1mo根据复查FFA、OCT结果对效果不佳患者可重复注射药物。随访6mo,对比B组和C组重复注射率。观察各组治疗前及治疗后1wk,1、3、6mo最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹视网膜厚度(central macular thickness,CMT)结果,统计各组并发症。结果:B组患者连续注射雷珠单抗2次者4眼,连续注射3次者7眼,重复注射率27.5%,C组均注射1次,B组重复注射率比C组高,差异有统计学意义(P<0.05);三组患者治疗后BCVA较治疗前均得到提高,CMT均较治疗前变薄,但B组和C组治疗后BCVA均高于A组,且CMT低于A组。另外,治疗后C组BCVA高于B组,CMT低于B组,但B组和C组BCVA和CMT、比较差异无统计学意义(P>0.05);直至随访结束,三组患者均无明显不良反应,B组与C组患者均未复发,A组复发率25%,差异有统计学意义(P<0.05)。结论:玻璃体腔注射康柏西普与雷珠单抗联合激光光凝治疗BRVO继发ME疗效均佳,但康柏西普联合激光治疗注射次数相对较少。

·AIM： To investigate the efficacy of intravitreal ranibizumab or conbercept combined with macular laser grid photocoagulation （ MLG ） for macular edema secondary to branch retinal vein occlusion （ BRVO） . ·METHODS： Totally 120 patients （ 120 eyes ） with BRVO were randomized into three groups, 40 patients （40 eyes） in each group. Group A received MLG alone; Group B：intravitreal injection of ranibizumab 0. 05mL/0. 5mg;Group C： intravitreal injection of conbercept 0. 05mL/0. 5mg. MLG were performed in Group B and Group A at 1wk after injection. At 1mo after injection, all the patients were examined with fundus fluorescein angiography and optical coherence tomography, repeated injections were given if necessary. Repeated injection rate of Group B and C was compared after a six-month follow-up. before and at 1wk, 1, 3, 6mo after treatment, best corrected visual acuity （ BCVA ） and central macular thickness （ CMT ） of the two groups were analyzed. ·RESULTS： In Group B, there were 4 eyes with 2 consecutive injections, 7 eyes with 3 consecutive injections, and the repeated injection rate was 27. 5%. Patients in Group C received injection only once. The repeated injection rate of Group B was higher than that of Group C with significant difference （P〈0. 05）. BCVA of the three groups were improved after treatment, CMT was less than those before treatment. BCVA of Group B and C after treatment was better than those of Group A and CMT was less. BCVA of Group C was better than that of Group＆amp;nbsp;B, and CMT was less without significant difference （ P〉0. 05）. After the follow-up, there were no significant adverse reactions in three groups. The recurrence rate of group A was 25%, no recurrence in Group B and C and the difference was statistically significant （P〈0. 05）. ·CONCLUSION： Intravitreal ranibizumab or Conbercept combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion is effective. But injection times of Conbercept is less.