雷珠单抗联合眼底激光治疗视网膜分支静脉阻塞继发黄斑水肿的价值研究

Clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion

目的 探讨雷珠单抗联合眼底激光治疗视网膜分支静脉阻塞(RVO)继发黄斑水肿的临床价值.方法 将2016年6月至2017年6月临汾市人民医院眼科收治的RVO继发黄斑水肿患者98例为研究对象,采用随机数字表法分为三组,A组(30例)采用单纯眼底激光治疗,B组(33例)采用单纯玻璃体腔注射雷珠单抗治疗,C组(35例)采用眼底激光联合玻璃体腔注射雷珠单抗治疗.比较三组患者治疗前后最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、渗漏发生率、注射次数以及并发症的差异.结果 A组、B组及C组治疗后3个月、6个月、9个月、12个月BCVA组间差异均有统计学意义(F=4.165、5.021、6.954,均P<0.05),且C组优于B组,B组优于A组(t=3.985、3.852、3.779、4.021、3.624、3.729,均P<0.05).治疗后A组、B组及C组3个月、6个月组间CMT差异均有统计学意义(F=6.772、14.025,均P<0.05),且C组小于B组,B组小于A组(t=5.325、11.251、3.992、6.895,均P<0.05).治疗6个月C组渗漏发生率(2.86%)低于B组(18.18%),B组低于A组(23.33%)(χ^2=6.148,P<0.05),B组平均注射雷珠单抗(2.93±1.52)次,明显少于C组的(2.00±0.56)次,差异有统计学意义(=3.349,P<0.05)].结论 雷珠单抗联合眼底激光治疗RVO继发黄斑水肿近期临床效果优于单纯激光治疗和雷珠单抗治疗,并可减少雷珠单抗注射次数.

Objective To investigate the clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion( RVO). Methods From June 2016 to June 2017,98 patients with RVO secondary macular edema in the People s Hospital of Linfen were randomly divided into three groups according to the digital table: A group (30 cases) treated with simple fundus laser, B group (33 cases) treated with intravitreal injection of ranibizumab, C group (35 cases) treated with fundus laser combined with intravitreal injection of ranibizumab. The best corrected visual acuity( BCVA),macular fovea thickness( CMT),leakage rate, injection times and complications were compared among the three groups before and after treatment. Results At 3 ,6, 9,12 months after treatment, the BCVA among A group, B group and C group had statistically significant differences (F =4. 165 ,5. 021,6. 954,all P <0. 05),and the BCVA of C group was better than that of B group,the BCVA of B group was better than that of A group (t = 3. 985,3. 852,3. 779,4. 021,3. 624,3. 729, all P < 0. 05 ). There were statistically significant differences in CMT among A group, B group and C group at 3 months and 6 months after treatment ( F = 6. 772,14. 025 , all P <0. 05),and the CMT of C group was less than that of B group, the CMT of B group was less than that of A group (t = 5. 325,11.251,3. 992,6. 895 ,all P <0. 05). At 6 months after treatment,the leakage rate in C group (2. 86%) was lower than that in B group (18. 18%),the leakage rate in B group was lower than that in A group (23. 33%)( χ^2=6. 148 ,P <0. 05). The injection times of ranibizumab in B group was (2. 93 ± 1.52),which was significantly less than that in C group (2. 00 ±0. 56)(t= 3. 349,P<0. 05). Conclusion The short - term clinical effect of ranibizumab combined with fundus laser in the treatment of macular edema secondary to RVO is better than laser therapy and ranibizumab alone, and the injection times of ranibizumab can be reduced.