玻璃体内注射雷珠单抗治疗中心性浆液性脉络膜视网膜病变的临床观察

Clinical observation on the efficacy of intravitreal injection of Ranibizumab for central serous chorioretinopathy

目的观察慢性中心性浆液性脉络膜视网膜病变（CSC）玻璃体内注射雷珠单抗的疗效。方法前瞻性队列研究。2015年12月至2017年1月慢性CSC45例（48只眼）行玻璃体内注射雷珠单抗治疗。分析注射前及注射后2、4及8周的视力，同时测量黄斑中心凹下脉络膜厚度（SFCT）及距黄斑中心凹1．5mm处上方、下方、鼻侧、颞侧四个方位黄斑中心区脉络膜厚度（CMCT）。结果注射后2、4及8周视力为0．24±0．19、0．18±0．17及0．16±0．20，均优于注射前的0．33±0．08，差异有统计学意义（F=18．50，P=0．00）。注射后3个时间点SFCT依次为（393．55±97．66）μm、（379．53±93．55）μm、（388．30±96．52）μm，均较注射前的（443．63±98．32）μm明显降低（F=103．54，P〈0．01）。CMCT4个测量点的脉络膜厚度变化趋势与SFCT者相一致。结论玻璃体内注射雷珠单抗治疗慢性CSC能够明显改善视力，降低后极部脉络膜厚度。

Objective To observe the efficacy of intravitreal injection of Ranibizumab for the treatment of chronic central serous chorioretinopathy （CSC）. Methods Prospective cohort study. Forty- eight eyes of 45 cases with chronic CSC from Dec. 2015 to Jan. 2017 were recruited in this study. All cases received intravitreal injection of Ranibizumab. The visual acuities were recorded before and 2, 4, 8 weeks after injection. Subfoveal choroidal thickness （SFCT） and central macular choroidal thickness （CMCT） of 1 500 μm superior, inferior, nasal and temporal to the fovea were measured by OCT. Results The visual acuity （ Log MAR） was 0.33 ± 0.08, 0.24 ± 0.19, 0.18 ± 0.17 and 0.16 ± 0.20 before and 2, 4, 8 weeks after injection. The visual aeuities at different time point after injection were better than that before injection. The difference was significant between before and after injection （ F = 18.50, P = 0.00 ）. SFCT before injection was （443.63 ±98.32）μm, which decreased significantly to （393.55±97.66） μm, （379.53 ± 93.55） μm,（388.30 ±96.52） μm at 2, 4, 8 weeks after treatment respectively（F = 105. 54, P 〈 0.01 ）. The changing trends of choroidal thickness measuring points were similar to the SFCT. Condusion Intravitreal injection of Ranibizumab for the treatment of chronic CSC can reduce posterior choroidal thickness and improve vision.