玻璃体腔内注射康柏西普治疗不同类型视网膜静脉阻塞合并黄斑水肿的疗效观察

Efficacy of intravitreal injection of Compaq in the treatment of macular edema associated with different types of retinal vein occlusion

目的观察玻璃体腔内注射康柏西普治疗视网膜中央静脉阻塞(CRVO)及视网膜分支静脉阻塞(BRVO)合并黄斑水肿(ME)的临床效果。方法选取2014年7月至2017年2月经北京市房山区良乡医院眼科诊断为视网膜静脉阻塞(RVO)合并ME患者27例(27只眼)的临床资料。将全部患者按照静脉阻塞类型分为两组,即CRVO组与BRVO组。CRVO组患者共8例(8只眼),BRVO组患者共19例(19只眼)。全部患者于玻璃体腔内注射康柏西普,每月1针,连续注射3针。检查并记录两组患者注射前、注射第一针后1周、第二针后1周、第三针后1周及第三针后1个月时患者的黄斑中心凹厚度(CMT)及最佳矫正视力(BCVA),并对结果进行统计学分析。采用重复测量资料的方差分析对治疗前后两组内不同时间点的BCVA及CMT数据进行统计分析,当差异有统计学意义时,进一步采用配对t检验进行两两比较。结果 CRVO组患者治疗前的CMT值为(768.50±344.93)μm,注射第三针后1个月时为(504.13±287.91)μm,二者比较差异有统计学意义(t=5.079,P<0.05)。治疗后各时间点的CMT值与治疗前比较均明显降低,差异有统计学意义(t=2.458,5.366,3.614,5.079;P<0.05)。BRVO组患者治疗前的CMT值为(650.47±317.67)μm,注射第三针后1个月时为(332.11±187.58)μm,二者比较差异有统计学意义(t=7.650,P<0.05)。治疗后各时间点的CMT值与治疗前比较均明显降低,差异有统计学意义(t=3.967,5.459,6.422,7.650;P<0.05)。CRVO组患者治疗前的BCVA为0.95±0.31,注射第三针后1个月时为0.76±0.35,二者比较差异有统计学意义(t=3.416,P<0.05)。第一针后1周时的BCVA与治疗前比较,差异无统计学意义(t=1.528,P>0.05)。此后各时间点的BCVA值与治疗前比较均显著改善,差异有统计学意义(t=2.376,2.553,3.416;P<0.05)。BRVO组患者治疗前的BCVA为0.68±0.34,注射第三针后1个月时为0.40±0.18,二者比较差异有统计学意义(t=5.931,P<0.05)。治疗后各时间点的BCVA值与治疗前比较均显著改善,差异有统计学意义(t=2.163,3.139,5.224,5.931;P<0.05)。两组患者治疗前BCVA值的差异无统计学意义(F=3.57,P>0.05)。将两组患者治疗后各时间点的BCVA改善情况进行比较,BRVO组明显优于CRVO组,且随注药次数的增加,差异越发明显,注射第三针后1个月时两组间的BCVA差异最为显著(F=7.20,8.28,9.01,12.68;P<0.05)。结论玻璃体腔注射康柏西普对于CRVO及BRVO合并ME的治疗安全有效。且BRVO患者的治疗效果较CRVO患者的治疗效果更显著。

Objective To observe the clinical efficacy of intravitreal injection of Compaq in the treatment of central retinal vein occlusion（ CRVO） and branch retinal vein occlusion（ BRVO） complicated with macular edema（ ME）. Methods The clinical data of 27 patients（ 27 eyes） with macular edema secondary to retinal vein occlusion（ RVO） diagnosed by ophthalmology in Liangxiang Hospital of Beijing Fangshan District from July 2014 to February 2017 were. The patients were divided into two groups according to the types of venous obstruction,that is,group CRVO（ group A） and group BRVO（ group B）. There were8 cases（ 8 eyes） in group A,and 19 cases（ 19 eyes） in group B. All patients were treated with intravitreal injection of Compaq,followed by a continuous infusion of 3 injections,with 1 injections per month. The CMT and BCVA of the two groups of patients were examined before and after the first injection,1 week after the first injection,1 week after the second injection,1 week after the third injection,and 1 month after the third injection,and the results were statistically analyzed. The variance of repeated measurement data were analyzed before and after treatment in two groups at different time points in the BCVA and CMT data,the difference was statistically significant, further paired t test was used for comparison of two groups.Results Before group A treatment,the CMT value was（ 768.50±344.93） μm,and（ 504.13± 287.91） μm1 month after the third injection,the difference was statistically significant（ t = 5.079,P〈0.05）. The CMT values at each time point after treatment were significantly lower than those before treatment（ t = 2. 458,5.366,3.614,5.079; P〈0.05）. The CMT value before treatment in group B was（ 650.47±317.67） μm,and（ 332.11±187.58） μm 1 month after the third injection,the difference was statistically significant（ t= 7.650,P〈0.05）. The CMT values at each time point after treatment were significantly lower than those before treatment（ t = 3.967,5. 459,6. 422,7. 650; P〈0. 05）. The BCVA in group A was 0. 95 ± 0. 31 before treatment and 0.76 ± 0. 35 1 month after the third injection. The difference was statistically significant（ t =3.416,P〈0. 05）. There was no statistical difference of BCVA between before and 1 week after the first injection（ t = 1.528,P〉0.05）. At each time point,BCVA values were significantly improved compared with those before treatment（ t = 2.376,2.553,3.416; P〈0.05）. The BCVA in the B group was 0.68±0.34 before treatment and 0.40±0. 18 1 month after the third injection. The difference was statistically significant（ t =5.931,P〈0.05）; At each time point after treatment,BCVA value was significantly improved compared with before treatment（ t = 2.163,3.139,5.224,5.931; P〈0.05）. There was no significant difference in BCVA value between the two groups before treatment（ F = 3.57,P〉0.05）. The two groups of patients at each time point after BCVA were observed and compared,B group was higher than that of group A,and with the increase in the number of injection,the difference is more obvious,1 month after the third injection,the difference of BCVA between the two groups was the most significant（ F = 7. 20,8. 28,9. 01,12. 68; P〈0.05）. Conclusion Intravitreal injection of Compaq is safe and effective in the treatment of secondary CRVO and BRVO with ME. and the treatment effect of BRVO is more significant than that of CRVO patients.