视网膜光凝联合玻璃体内注射雷珠单抗治疗缺血型视网膜分支静脉阻塞(BRVO)致黄斑水肿的疗效

Efficacy of intravitreal ranibizumab combined with laser photocoagulation for the treatment of macular edema induced by ischemic branch retinal vein occlusion

目的观察视网膜光凝联合玻璃体内注射雷珠单抗治疗缺血型视网膜分支静脉阻塞(retinal branch vein occlusion,BRVO)致黄斑水肿的疗效。方法选取在鞍山市中心医院眼科就诊的BRVO患者60例60眼,随机分为三组,20例行玻璃体内注射雷珠单抗治疗(A组)、20例行视网膜激光光凝治疗(B组)、20例行视网膜激光光凝联合玻璃体内注射雷珠单抗治疗(C组)。术前行最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯、眼底及眼压、眼底荧光血管造影(fundus fluorescein angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT)检查;术后第1天进行BCVA、裂隙灯及眼压检查;术后1个月、2个月、3个月分别行BCVA、裂隙灯、眼底及眼压检查,并利用OCT观察黄斑水肿。通过观察上述指标比较三组术后BCVA及黄斑中心凹厚度(central macular thickness,CMT)是否存在差异。结果三组患者治疗后1个月、2个月、3个月BCVA较治疗前均有提高,差异均有统计学意义(均为P<0.05)。治疗后2个月、3个月,A组BCVA为0.26±0.14、0.26±0.14,优于B组的0.39±0.10、0.40±0.10,差异均有统计学意义(均为P<0.05)。治疗后3个月,C组BCVA为0.14±0.11,优于A组0.26±0.14,差异有统计学意义(P<0.05)。治疗后1个月、2个月、3个月,C组BCVA为0.30±0.13、0.20±0.12、0.14±0.11,优于B组0.43±0.10、0.39±0.10、0.40±0.10,差异均有统计学意义(均为P<0.05)。三组患者治疗后1个月、2个月、3个月CMT较治疗前均有提高,差异均有统计学意义(均为P<0.05)。治疗后1个月、2个月、3个月,C组CMT为(318.85±71.48)μm、(287.15±56.71)μm、(255.05±60.90)μm,优于A组(347.00±67.59)μm、(305.10±47.44)μm、(282.40±36.26)μm和B组(417.05±63.94)μm、(394.80±57.18)μm、(375.90±55.10)μm,差异均有统计学意义(均为P<0.05)。治疗后2个月、3个月,A组CMT优于B组,差异均有统计学意义(均为P<0.05)。结论视网膜激光光凝联合玻璃体内注射雷珠单抗治疗BRVO致黄斑水肿疗效较好,效果优于单纯视网膜激光光凝或单纯玻璃体内注射雷珠单抗。

Objective To observe the therapeutic efficacy of intravitreal ranibizumab combined with laser photocoagulation for the treatment of macular edema associated with ischemic branch retinal vein occlusion(BRVO).Methods Together 60 patients(60 eyes)with BRVO in Anshan City Central Hospital were included and divided into three groups,20 patients with intravitreal ranibizumab treatment as A group,20 patients with retinal laser photocoagulation treatment as B group,and another 20 patients with intravitreal ranibizumab combined with retinal laser photocoagulation therapy as C group,followed by the preoperative observation of the best corrected visual acuity(BCVA),slit lamp,fundus and intraocular pressure examination,fundus fluorescein angiography(FFA),optical coherence tomography(OCT).One day after the surgery,BCVA,slit lamp and intraocular pressure examination were conducted,and 1 month,2 months,3 months after the surgery,observation of BCVA,slit lamp,fundus and intraocular pressure examination were performed.Then,OCT was used to determine the status of macular edema.And finally,BCVA and central macular thickness(CMT)in the three groups were statistically analyzed by observing the above indicators.Results The BCVA at 1 month,2 months,and 3 months after treatment was higher than before treatment in all three groups,and the differences were statistically significant(all P<0.05).The BCVA of A group was 0.26±0.14 and 0.26±0.14 at 2 and 3 months after treatment,respectively,which was significantly better than that of B group(0.39±0.10 and 0.40±0.10)(all P<0.05).At 3 months after treatment,the BCVA in C group was 0.14±0.11,which was significantly higher than that in A group(0.26±0.14)(P<0.05).The BCVA of C group was 0.30±0.13,0.20±0.12,0.14±0.11 at 1 month,2 months and 3 months after treatment,respectively,which was better than that of B group(0.43±0.10,0.39±0.10,0.40±0.10),and the differences were statistically significant(all P<0.05).The postoperative CMT was significantly reduced when compared with preoperation in all three groups(all P<0.05).The CMT at 1 month,2 months and 3 months after treatment in C group was(318.85±71.48)μm,(287.15±56.71)μm and(255.05±60.90)μm,respectively,which was better than that in A group[(347.00±67.59)μm(305.10±47.44)μm and(282.40±36.26)μm],and B group[(417.05±63.94)μm,(394.80±57.18)μm,and(375.90±55.10)μm],with significant differences(all P<0.05).At 2 months and 3 months after treatment,CMT in A group was better than that in B group,and the difference was statistically significant(P<0.05).Conclusion The efficacy of retinal laser photocoagulation combined with intravitreal ranibizumab in the treatment of BRVO macular edema is better than simple retinal laser photocoagulation and simple intravitreal ranibizumab.