雷珠单抗治疗BRVO-ME的临床疗效及视力预后相关因素分析

Analysis on the clinical effect and visual acuity prognostic factors of BRVO-ME treated with Ranibizumab

目的:分析雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)患者黄斑区视网膜结构和功能的改善情况,并探讨影响视力预后的相关因素。方法:前瞻性临床研究。选取2018-06/2019-05于我院眼科确诊的BRVO-ME患者25例25眼,均接受每月1次,连续3次玻璃体腔注射雷珠单抗治疗。分别于治疗前和第3次玻璃体腔注射1mo后检测最佳矫正视力(BCVA),并利用相干光断层扫描成像(OCT和OCTA)技术检测黄斑中心凹厚度(CMT),评估浅层视网膜毛细血管网的血管长度密度(VLD)、血管灌注密度(VPD)、中心凹无血管区面积(FAZ),通过多焦视网膜电流图(mf-ERG)分析一环和二环(中央凹)的N1、P1波潜伏期及P1波振幅密度。结果:治疗后,本组患者BCVA(LogMAR)较治疗前显著改善(0.323±0.086 vs 0.773±0.304,P<0.05);CMT显著降低(239.385±33.175μm vs 489.346±137.453μm,P<0.05),而VLD、VPD、FAZ均无明显变化(P>0.05);一环和二环N1波潜伏期、P1波潜伏期显著降低,且P1波振幅密度值显著提高(P<0.05)。Pearson相关性分析显示,年龄、治疗前BCVA、VLD、VPD、FAZ与治疗前后视力变化值具有显著相关性(均P<0.05)。结论:玻璃体腔内注射雷珠单抗治疗BRVO-ME可显著降低黄斑水肿,改善视力及黄斑区结构和功能,年龄、基线BCVA、黄斑区微结构参数可作为评估视力改善的预测指标。

AIM:To evaluate the functional and structural changes of foveal macula after intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion(BRVO-ME)and screen the factors that can predict the final visual acuity of the patients.METHODS:Prospective,clinical study.In this prospective single-arm study,we observed 25 patients(25 eyes)diagnosed with BRVO-ME who were enrolled from 2018.6-2019.5 in the first central hospital of Baoding.All patients received monthly ranibizumab 0.5mg injections for 3 consecutive months.The best-corrected visual acuity(BCVA),the central macular thickness(CMT)and the vessel perfusion density(VPD),vessel length density(VLD)and fovea avascular zone(FAZ)of superficial capillary plexus(SCP)were evaluated detected by optical coherence tomography(OCT and OCTA)before and 1mo after the third injection.Mf-ERG was used to analyze the amplitude density of P1 wave and latency of P1,N1 wave from ring 1 and ring 2.RESULTS:After treatment,BCVA(LogMAR)was improved significantly compared with that before(0.323±0.086 vs 0.773±0.304,P<0.05).CMT was lower than before(239.385±33.175μm vs 489.346±137.453μm,P<0.05),but there was no significant change in FAZ,VPD and VLD of SCP within 6mm×6mm of macular area before and after treatment(P>0.05).The latency of P1,N1 wave of ring 1 and ring 2 were significantly decresed from baseline,while the amplitude density of P1 wave was increased(P<0.05).Pearson correlation analysis shows that age,baseline BCVA,VLD,VPD,FAZ were significantly correlated with changes in visual acuity before and after treatment(P<0.05).CONCLUSION:In patients with BRVO-ME,ranibizumab therapy can reduce CMT,improve BCVA and improve the structure and function of macular area.Age,BCVA before treatment and microstructure parameters of macular area can be used as predictors of vision improvement.