玻璃体内注射雷珠单抗对年龄相关性黄斑变性患者眼表的影响

Clinical study of ocular surface damage caused by intravitreal injection of Ranibizumab in patients with age-related macular degeneration

目的探究玻璃体内注射药物对年龄相关性黄斑变性(age-related macular degeneration,AMD)患者眼表的影响。方法选取南昌大学第一附属医院眼科住院部18例(均单眼患病)被诊断为AMD且需进行玻璃体内注射雷珠单抗治疗的患者为研究对象,其中,患眼作为A组进行3次玻璃体内注射雷珠单抗治疗;对侧健康眼作为B组不进行任何治疗。双眼均在治疗前及3次治疗结束后6 h进行相关检测。对比两组患者治疗前后泪液分泌测试(Schirmer I test,SIT)、泪膜破裂时间(break-up time,BUT)、角膜荧光素染色(corneal fluorescein staining,CSF)及眼部症状和体征评分情况。结果两组治疗前泪河高度相比,差异无统计学意义(P>0.05);A组治疗前和治疗后的最佳矫正视力和治疗后的泪河高度均低于B组,差异均有统计学意义(均为P<0.05);与治疗前相比,A组治疗后的最佳矫正视力明显上升,泪河高度明显下降,差异均具有统计学意义(均为P<0.05);B组最佳矫正视力、泪河高度改变均不明显,差异均无统计学意义(均为P>0.05)。A组治疗后均出现了浅表点状上皮糜烂,B组治疗前后及A组治疗前均未见浅表点状上皮糜烂。两组治疗前的各项眼部症状评分相比,差异均无统计学意义(均为P>0.05);治疗后,A组各项眼部症状评分与治疗前相比均明显升高,且均高于B组,差异均有统计学意义(均为P<0.05);B组各项眼部症状评分改变不明显(均为P>0.05)。两组治疗前OSDI评分、SIT、CSF评分相比,差异均无统计学意义(均为P>0.05);A组治疗后OSDI评分、CSF评分均高于B组,SIT低于B组,差异均有统计学意义(均为P<0.05);与治疗前相比,A组治疗后OSDI评分、CSF评分均明显上升,SIT明显下降,差异均有统计学意义(均为P<0.05),B组OSDI评分、SIT、CSF评分改变均不明显(均为P>0.05)。结论玻璃体内注射雷珠单抗会损伤AMD患者的眼表。

Objective To explore the effect of drug intravitreously injected on ocular surface of patient with age-related macular degeneration(AMD).Methods The study enrolled 18 patients(monocular sick)diagnosed with AMD and underwent intravitreal injection of Ranibizumab in Inpatient Department of Ophthalmology of the First Affiliated Hospital of Nanchang University.The affected eyes received intravitreal injection of Ranibizumab for 3 times as group A,and the contralateral eyes were treated as group B without any treatment.Relevant measures were taken in both eyes before treatment and 6 hours after 3 treatments,respectively.The Schirmer I Test(SIT),break-up time(BUT)of tear film,corneal fluorescein(FL)staining and ocular symptom and sign scores were compared in both two groups before and after treatment.Results There was no significant difference in tear meniscus height(TMH)between the two groups before treatment(P>0.05).The best corrected visual acuity(BCVA)before and after treatment and TMH after treatment in group A were lower than those in group B,and statistical differences were found(all P<0.05).Compared with that before treatment,BCVA significantly increased and TMH obviously decreased in group A after treatment,and statistical differences were found(both P<0.05).There was no significant difference in BCVA or TMH between before and after operation in group B(both P>0.05).Superficial punctate epithelial erosion(SPEE)occurred in group A after treatment,but not in group B before or after treatment or in group A before treatment.There was no significant difference in the scores of ocular symptoms before operation between the two groups(all P>0.05).Scores of ocular symptoms obviously improved after treatment in group A compared with those before treatment,and were higher than those in group B(all P<0.05).No obvious improvement was found in scores of ocular symptoms in group B(all P>0.05).There was no significant difference in OSDI score,SIT or CSF score between the two groups before treatment(all P>0.05).After treatment,OSDI and CSF scores in group A were higher than those in group B,and SIT was lower than that in group B(all P<0.05).Compared with those before treatment,OSDI and CSF scores increased significantly,and SIT decreased significantly after treatment in group A(all P<0.05);there was without obvious change in OSCI score,SIT or CSF score in group B before and after treatment(all P>0.05).Conclusion Intravitreal injection of Ranibizumab can damage the ocular surface of AMD patients.