玻璃体内注射康柏西普联合后筋膜囊注射曲安奈德对视网膜中央静脉阻塞继发顽固性黄斑水肿患者的治疗效果

Efficacy of intravitreal injection of Conbercept combined with posterior fascial capsular injection of Triamcinolone Acetonide for treatment of macular edema secondary to central retinal vein occlusion

目的探讨玻璃体内注射康柏西普联合后筋膜囊注射曲安奈德治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发顽固性黄斑水肿的安全性及有效性。方法选取2015年3月至2017年12月于中日友好医院眼科就诊的CRVO继发顽固性黄斑水肿的患者28例(28眼),采用玻璃体内注射康柏西普联合后筋膜囊注射曲安奈德对患者进行治疗,至少随访1 a。记录患者历次随访时的最佳矫正视力(logMAR)、眼压、黄斑中央视网膜厚度(central macular thickness,CMT)以及联合治疗前后注药次数、注药间隔时间,观察眼部及全身并发症。使用SPSS19.0进行数据统计分析。结果联合治疗后的注药次数为7.8±4.2,与联合治疗前(13.5±6.1)相比显著降低,差异有统计学意义(P=0.010)。联合治疗后注药间隔时间为(8.8±4.5)周,与联合治疗前(4.9±2.6)周相比显著延长,差异有统计学意义(P=0.018)。初诊时患者CMT为(599.56±302.41)μm,在联合治疗前降低为(498.13±415.64)μm,联合治疗后进一步降低至(279.88±152.83)μm,三者比较差异有统计学意义(P<0.001)。联合治疗后患者CMT,与初诊时以及联合治疗前相比均显著降低,差异均有统计学意义(均为P<0.05)。联合治疗后患者最佳矫正视力,与初诊时相比显著提高,差异有统计学意义(P=0.006);较联合治疗前提高不明显(P=0.093)。联合治疗后,28眼中有5眼出现一过性眼压升高,最高为34.00 mmHg(1 kPa=7.5 mmHg),局部滴用降眼压药物(最多不超过3种)后均可控制。治疗后,22眼自身晶状体患眼均未观察到明显白内障进展;所有患眼均无眼内炎、视网膜脱离、玻璃体积血等并发症发生。结论玻璃体内注射康柏西普联合后筋膜囊注射曲安奈德治疗膜中央静脉阻塞继发顽固性黄斑水肿疗效较好且较安全,能减少注药次数,延长注药间隔时间。

Objective To investigate the efficacy and safety of intravitreal injection of Conbercept combined with posterior fascial capsular injection of Triamcinolone Acetonide for treatment of macular edema secondary to central retinal vein occlusion(CRVO).Methods The study enrolled 28 patients(28 eyes)with refractory macular edema secondary to CRVO and received treatment at China-Japan Friendship Hospital from March 2015 to December 2017.All patients received intravitreal injection of Conbercept combined with posterior fascial capsular injection of Triamcinolone Acetonide,and followed up for at least a year.Best corrected vision acuity(BCVA;logMAR),intraocular pressure(IOP),central macular thickness(CMT)at every visit,and frequency of injections and injection interval were recorded before and after combination therapy,ocular and general symptoms were recorded before and after combination therapy.SPSS 19.0 was adopted for analysis of adverse events.Results The frequency of injections was 7.8±4.2 after combination therapy,which was significantly lower than 13.5±6.1 before combination therapy,and the difference was statistically significant(P=0.010).The injection interval extended to(8.8±4.5)weeks after combination therapy from(4.9±2.6)weeks before combination therapy,and the difference was statistically significant(P=0.018).The CMT at first visit was(599.56±302.41)μm,decreased to(498.13±415.64)μm before combination therapy and(279.88±152.83)μm after combination therapy;there was a statistically significant difference among the 3 time points(P<0.001).The CMT after combination therapy was statistically significantly lower than either first visit or before combination therapy(both P<0.05).BCVA after combination therapy improved significantly compared with that at first visit(P=0.006),but had no significant difference with that before combination therapy(P=0.093).Transient elevated IOP was observed in 5 eyes of these 28 eyes after combination therapy,and got up to 34.00 mmHg(1 kPa=7.5 mmHg).Local administration of ocular hypotensive agents(not more than 3 kinds)can controlled the symptoms.After treatment,22 autolens affected eyes had no obvious progression of cataract;all affected eyes were without endoophthalmitis,retinal detachment,vitreous hemorrhage or other complication.Conclusion Intravitreal injection of Conbercept combined with posterior fascial capsular injection of Triamcinolone Acetonide is a safe and effective method for treatment of macular edema secondary to CRVO,and can reduce injection frequency,extend injection interval.