OCT参数作为雷珠单抗治疗视网膜中央静脉阻塞继发黄斑水肿疗效的预测指标

OCT parameters as a predictor of the efficacy of Ranibizumab in the treatment of macular edema secondary to central retinal vein occlusion

目的:分析光学相干断层扫描(OCT)参数与中央静脉阻塞继发黄斑水肿(CRVO-ME)的关系,并比较雷珠单抗联合激光光凝术与单纯雷珠单抗治疗CRVO-ME的临床疗效。方法:纳入2020-01/12我院眼科诊治的CRVO-ME患者43例43眼,分为A、B两组,A组患者采用雷珠单抗联合激光光凝术治疗,B组患者采用单纯雷珠单抗治疗。分别于治疗前、治疗后1、3、6、12mo时进行OCT和荧光素血管造影(FFA)检查,观察外层视网膜结构,建立“SAVE”评分,分析其与最佳矫正视力(BCVA,LogMAR)的关系。比较两组患者治疗前后BCVA、黄斑中心凹厚度(CMT)、眼压、平均药物注射次数。结果:治疗后12mo, OCT基线外界膜(ELM)完整组、基线椭圆体带(EZ)完整组治疗前后BCVA改善均显著大于断裂组(0.47±0.16 vs 0.21±0.15,P=0.013;0.44±0.20 vs 0.25±0.17,P=0.008)。基线RPE断裂组与RPE完整组之间BCVA变化无差异(P>0.05)。两组患者“S”和“A”评分为1分的数量在治疗后12mo均显著下降,治疗前“V”和“E”评分为“0”的患者BCVA改善显著高于得分为“1”的患者(均P<0.05)。治疗后A、B两组患者BCVA、CMT均较治疗前显著改善(P<0.05),两组间BCVA、CMT及药物注射次数比较均无差异(P>0.05)。两组患者均未出现继发性青光眼、眼内炎等严重并发症。结论:ELM、EZ的基线状态、有无玻璃体-视网膜异常(V)及局灶性渗漏(E)可提示CRVO-ME结果。雷珠单抗治疗CRVO-ME具有显著的疗效和良好安全性,雷珠单抗联合激光光凝未见更好的效果。

AIM:To analyze the correlation between optical coherence tomography(OCT) parameters and central retinal vein occlusion of macular edema secondary(CRVO-ME), and compare the clinical efficacy of ranibizumab combined with laser photocoagulation and ranibizumab alone in the treatment of CRVO-ME.METHODS:There were 43 case with 43 eyes of patients in CRVO-ME diagnosed in our hospital from January 2020 to December 2020 included in the present study and divided into two groups, namely A and B. Patients in group A were treated with ranibizumab combined with laser photocoagulation, while patients in group B were treated with ranibizumab alone. The structure of outer retina and “SAVE” scores were observed and estimated using OCT and fluorescein angiography(FFA) examination before and after the treatment at 1, 3, 6, 12 mo, and then analyzed their correlation with best corrected visual acuity(BCVA, LogMAR). The BCVA, central macular thickness(CMT), intraocular pressure and average number of drug injections were also compared between the two groups before and after treatment.RESULTS:At 12 mo after treatment, the BCVA in the OCT baseline external limiting membrane(ELM) intact group and baseline ellipsoid zone(EZ) intact group before and after treatment were significantly improved than those of the fracture group(0.47±0.16 vs 0.21±0.15, P=0.013;0.44±0.20 vs 0.25±0.17, P=0.008). There was no statistically significant difference in BCVA changes between baseline RPE fracture group and RPE intact group(P>0.05). The number of patients with “S” and “A” at 1 score decreased significantly at 12 mo after treatment in both groups, the BCVA of patients with “V” and “E” at 0 score before treatment was significantly improved than those patients at 1 score(all P<0.05). The BCVA and CMT of patients after treatment in groups A and B were both significant improved compared with before treatment(P<0.05). There were no significant differences in the BCVA and CMT in the number of drug injections between the two groups(P>0.05). In addition, there were no severe complications such as secondary glaucoma and endophthalmitis in both groups.CONCLUSION: Baseline status of ELM and EZ, presence or absence of vitreoretinal abnormalities(V), and focal leakage(E) could suggest the treatment efficacy of CRVO-ME. Ranibizumab in the treatment of CRVO-ME demonstrates prominent efficacy and great safety, and there was no better effect was observed when combined with laser photocoagulation.