玻璃体注射雷珠单抗治疗视网膜中央静脉阻塞继发黄斑水肿的短期效果

The effects of intravitreal injection of ranibizumab in treatment of macular edema secondary to central retinal vein occlusion

目的探讨玻璃体注射雷珠单抗治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿的效果。设计前瞻性比较性病例系列。研究对象46例CRVO继发黄斑水肿患者(46眼)。方法采用随机分层法分为对照组(n=23例,予以玻璃体注射4 mg/0.1ml曲安奈德)和观察组(n=23例,玻璃体注射0.5 mg/0.05ml雷珠单抗)。于治疗后1、4、8、12、24周,观察治疗效果。主要指标最佳矫正视力(BCVA),黄斑中心凹厚度(CMT),眼压。结果(1)治疗后1、4、8、12、24周,两组患者视力改善有效率对比差异无统计学意义(P=0.760、0.765、0.552、0.767、0.555);(2)两组患者不同时间点BCVA组内比较差异均有统计学意义(F=4.373,P=0.000;F=3.472,P=0.008)。在各时间点上,两组患者BCVA比较差异无统计学意义(P=1.000、0.339、0.484、0.886、0.502、0.560);(3)两组患者不同时间点CMT组内比较差异均存在统计学意义(F=3.891,P=0.000;F=3.571,P=0.002)。在各时间点上,两组患者CMT比较差异无统计学意义(P=0.855、0.869、0.915、0.892、0.874、0.564)。(4)观察组不同时间点眼压比较差异无统计学意义(F=2.341,P=0.137),对照组组内比较差异有统计学意义(F=2.569,P=0.049)。在治疗后4周和24周,观察组患者眼压值明显低于对照组(P=0.008、0.042),其余时间点,两组患者眼压值差异无统计学意义(P=0.216、0.161、0.242)。(5)在随访过程中,对照组患者出现2例(8.70%)眼压升高,观察组患者未出现其他并发症。结论玻璃体注射雷珠单抗治疗CRVO继发黄斑水肿效果较好,在提高BCVA及降低CMT方面与曲安奈德相当,但在避免眼压升高方面优于曲安奈德,治疗安全性较高。

Objective To discuss the effects of intravitreal injection of ranibizumab in treatment of macular edema secondary to central retinal vein occlusion（CRVO）. Design Prospective comparative case series. Participants 46 patients with macular edema secondary to CRVO（46 eyes）. Method Using random stratified method, they were divided into control group（n=23 cases, 4 mg/0.1 ml in-travitreal injection of Triamcinolone Acetonide） and study group（n=23 cases, 0.5 mg/0.05 ml intravitreal injection of ranibizumab）. At 1week, 4 weeks, 8 weeks, 12 weeks and 24 weeks after the treatment, the therapeutic effects were observed. Main Outcome Measures Best corrected visual acuity（BCVA）, central macular thickness（CMT）, intraocular pressure（IOP）. Results（1） There was no statistically significant difference in terms of visual acuity improvement between the two groups（ P=0.760, 0.765, 0.552, 0.767, 0.555）;（2） The BCVA was significantly different at different time points within the two groups（F=4.373, P=0.000; F=3.472, P=0.008）, but not significantly different between the two groups（P =1.000, 0.339, 0.484, 0.886, 0.502, 0.560）;（3） The CMT was significantly different at different points withing the two groups（F=3.891, P=0.000; F=3.571, P=0.002）, but not significantly different between the two groups（P=0.855,0.869, 0.915, 0.892, 0.874, 0.564）.（4） The IOP was not significantly different at different time points in the study group（ F=2.341, P=0.137）. The IOP was significantly different at different time points in the control group（F =2.569, P=0.049）. However, at week 4 and week 24, the IOP value was significantly lower in the study group than the control group（P=0.008, 0.042）. At other time points the IOP was not significantly different（P=0.216, 0.161, 0.242）.（5） During the follow-up, there was two patients（8.70%） in the control group showed elevated IOP. There was no complications recorded in the study group. Conclusion The intravitreal injection of ranibizumab for treatment of macular edema secondary to central retinal vein occlusion is effective and safe.