比较两种方案行玻璃体注射雷珠单抗治疗CRVO继发黄斑水肿

Comparison of two different regimens of intravitreal ranibizumab therapy for macular edema secondary to central retinal vein occlusion

目的比较1次玻璃体注射雷珠单抗+按需重复注射(1+PRN)和连续3次玻璃体注射雷珠单抗+按需重复注射(3+PRN)两种方案治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿的临床疗效。设计非随机病例对照研究。研究对象2015年12月-2017年2月在成都市第二人民医院眼科临床确诊为CRVO继发黄斑水肿的患者49例(49眼)。方法所有患者均给予玻璃体注射雷珠单抗0.5 mg治疗,按治疗方案不同,分为1+PRN组(29眼)和3+PRN组(20眼),存在周边视网膜无灌注区者予联合视网膜激光光凝治疗,治疗后每月随访1次,观察1年,统计两组患眼的玻璃体注药次数;对比分析两组患眼的最佳矫正视力(BCVA)和黄斑中心凹视网膜厚度(CFT)。主要指标玻璃体注药次数,BCVA和CFT。结果平均注射次数,1+PRN组为(4.1±2.8)次,3+PRN组较多,为(5.9±2.1)次(P=0.022)。随访12个月,1+PRN组的BCVA(LogMAR)从基线的0.481±0.258提高到0.344±0.376;CFT值由基线时的(599.3±191.3)μm减少到(318.8±124.8)μm;3+PRN组的BCVA(LogMAR)从基线的0.467±0.343提高到0.325±0.315;CFT值由基线时的(644.4±237.4)μm减少到(335.5±153.6)μm;两组患者基线及最终的BCVA和CFT均无统计学差异。结论玻璃体注射雷珠单抗治疗CRVO继发黄斑水肿,1+PRN和3+PRN两种方案随访12个月的BCVA和CFT疗效相似,但1+PRN组的注射次数更少。(眼科,2019, 28:111-114)

Objective To compare the efficacy of two different regimens of ranibizumab for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). The two different regimens were 1 initial injection+pro re nata (PRN) administration and 3 successive monthly initial injections + PRN. Design Non-random case-control study. Participants 49 cases (49 eyes) who were diagnosed with macular edema secondary to CRVO in Chengdu second people's Hospital from December 2015 to February 2017. The average age was 60.5±12.1 years old. Method All patients were treated with intravitreal injection of ranibizumab 0.5 mg. According to the different injection regimens, patients were divided into 2 groups: 29 eyes received 1 initial injection (1+PRN group) and 20 eyes received 3 monthly loading injections (3+PRN group). The patients with peripheral retinal non-perfusion area were additionally given with peripheral retinal laser photocoagulation. The patients were followed monthly for 1 year. The number of injections was counted. The changes of BCVA and CFT were compared between the two groups. Main Outcome Measures The number of injections, BCVA and CFT. Results The number of injections in the 1+PRN group was significantly lower than 3+PRN group (4.1±2.8 versus 5.9±2.1, P=0.02) during the 12-month follow-up period. The BCVA (logMAR) increased from baseline 0.481±0.258 to 0.344±0.376 in 1+PRN group and from baseline 0.467±0.343 to 0.325±0.315 in 3+PRN group. At month 12, the CFT decreased from baseline 599.3±191.3 μm to 318.8±124.8 μm in 1+PRN group and from 644.4±237.4 μm to 335.5±153.6μm in 3+PRN group respectively. There was no significant difference in BCVA and CFT between the two groups at both baseline and final visit. Conclusions Using ranibizumab for macular edema secondary to CRVO, 1+PRN regimen achieved similar 12-month outcomes to 3+PRN regimen with fewer injections.