雷珠单抗及微脉冲激光治疗视网膜静脉阻塞继发黄斑水肿

Efficacy of ranibizumab combined with micropulse laser photocoagulation for macular edema secondary to retinal vein occlusion

目的:评估玻璃体内注射雷珠单抗及微脉冲激光治疗视网膜静脉阻塞继发黄斑水肿的临床疗效。方法:回顾性分析广州医科大学附属第六医院2018年7月至2019年7月视网膜静脉阻塞继发黄斑水肿共40例(40眼)的临床资料。包括视网膜分支静脉阻塞(BRVO)组20例(20眼)和视网膜中央静脉阻塞(CRVO)组20例(20眼)。所有患者均接受玻璃体内注射0.5 mg雷珠单抗,1周后行黄斑区532 nm阈下微脉冲激光光凝联合周边无灌注区播散性光凝或广泛视网膜光凝。随访6个月,观察其临床疗效。结果:两组治疗后7天、1、2、3及6个月视力均较术前提高(P<0.05),BVRO组视力提高更快,两组间差异有统计学意义(t=-3.742、-5.547、-5.205、-5.021、-2.076,均P<0.05)。两组黄斑中心区厚度(CMT)治疗后逐步降低,与治疗前相比差异均有统计学意义(P<0.05)。两组间各时间点CMT比较,差异无统计学意义(P>0.05)。玻璃体内注药次数BRVO组平均为(1.75±0.91)次,CRVO组平均为(2.80±0.89)次,差异有统计学意义(t=-3.679,P=0.001)。结论:玻璃体内注射雷珠单抗及532 nm阈下微脉冲激光治疗视网膜静脉阻塞继发黄斑水肿可有效促进出血吸收、改善黄斑水肿、提高视力。

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with laser photocoagulation for the treatment of macular edema secondary to retinal vein occlusion(RVO).Methods The data of 40 eyes of 40 cases with RVO-ME in the Sixth Hospital Affiliated of Guangzhou Medical University from Jul.2018 to Jul.2019 were analyzed retrospectively.There were 20 eyes of 20 cases in branch retinal vein occlusion(BRVO)group and 20 eyes of 20 cases in central retinal vein occlusion(CRVO)group.All patients received intravitreal injection of 0.5 mg ranibizumab.At 1 week after injection,all cases received 532 nm subthreshold micropulse photocoagulation in the macular area combined with spread photocoagulation/pan retinal photocoagulation in peripheral non-perfusion area.The patients were followed up for 6 months.The clinical efficacy was observed.Results After treatment,BCVA were better than that before treatment in the two groups,and the difference were statistically significant(P<0.05).The difference of visual acuity at 7 days,1,2,3 and 6 months after treatment were statistically significant between the two groups(t=-3.742,-5.547,-5.205,-5.021,-2.076,all P<0.05).Central macular thickness in the two groups decreased gradually after treatment,and the differences were statistically significant between before and after treatment(P<0.05).There was no statistically significant difference between the two groups at every time points after treatment(P>0.05).The average times of intravitreal injection was(1.75±0.91)times in the BRVO group and(2.80±0.89)times in the CRVO group.The difference was statistically significant(t=-3.679,P=0.001).Conclusion Intravitreal injection of ranibizumab with 532 nm subthreshold micropulse laser photocoagulation for macular edema secondary to retinal vein occlusion can effectively promote the absorption of bleeding,ameliorate macular edema,and improve vision.