雷珠单抗注射后不同时间点光凝治疗缺血型视网膜中央静脉阻塞的疗效对比

Comparison of the efficacy of photocoagulation at different time points after ranibizumab injection in the treatment of ischemic central retinal vein obstruction

目的:比较雷珠单抗玻璃体注射后不同时间点视网膜激光光凝术治疗缺血型视网膜中央静脉阻塞(CRVO)的临床疗效。方法:选择2020年1—10月本院收治的94例缺血型CRVO患者,随机分为观察组和对照组,每组47例。两组均行雷珠单抗玻璃体注射,1次/月,连续3个月。对照组光凝治疗时间为最后1次雷珠单抗玻璃体注射后3 d,之后每周1次,连续3次,观察组则在每次雷珠单抗玻璃体注射后3 d。比较两组临床疗效、最佳矫正视力、黄斑中央厚度、并发症发生率和复发率。检测患者玻璃体腔液中血管内皮生长因子(VEGF)、白细胞介素(IL)-6和IL-8水平及球结膜微循环指标(患眼细动脉管径、细静脉管径、红细胞聚集积分)。结果:观察组临床总有效率为95.75%,高于对照组的82.98%(P<0.05)。与对照组比较,观察组治疗后最佳矫正视力升高,黄斑中央厚度减小,玻璃体腔液VEGF、IL-6、及IL-8水平降低,细动脉管径、细静脉管径缩小,红细胞聚集积分降低(均P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。视网膜激光光凝治疗完成后1年内观察组复发率为6.38%,低于对照组的21.28%(P<0.05)。结论:与雷珠单抗玻璃体3次注射后行激光治疗相比,每次雷珠单抗玻璃体注射后行激光治疗可提高缺血性CRVO的疗效,改善患者视力,抑制玻璃体炎症,减少复发。

Objective: To compare the clinical efficacy of retinal laser photocoagulation for ischemic central retinal vein occlusion(CRVO) at different time points after intravitreal injection of ranibizumab. Methods: Ninetyfour patients with ischemic CRVO admitted to our hospital from January to October 2020 were randomly divided into an observation group and a control group, with 47 cases in each group. Both groups were administered intravitreal ranibizumab injection, once per month for 3 months. The control group was treated with photocoagulation3 d after the last ranibizumab injection and then once a week for 3 consecutive times, while the observation group was treated 3 d after each intravitreal ranibizumab injection. The clinical efficacy, best corrected visual acuity,central macular thickness, complication rate and recurrence rate were compared between the two groups. The levels of vascular endothelial growth factor(VEGF), interleukin(IL)-6 and IL-8 in the vitreous humor and the microcirculation indexes of the bulbar conjunctiva(fine artery diameter, fine vein diameter, and red blood cell aggregation score in the affected eyes) were measured. Results: The total clinical efficiency of the observation group was95.75%, which was higher than that of the control group(82.98%)(P < 0.05). Compared with the control group,the best corrected visual acuity increased, the central macular thickness decreased, the vitreous humor VEGF, IL-6, and IL-8 levels decreased, the fine arterial canal diameter and fine venous canal diameter decreased, and the erythrocyte aggregation score decreased in the observation group after treatment(all P < 0.05). There was no statistically significant difference in the complication rate between the two groups(P > 0.05). The recurrence rate in the observation group was 6.38% within 1 year after the completion of retinal laser photocoagulation, which was lower than that of the control group(21.28%)(P<0.05). Conclusion: Compared with laser treatment after 3 intravitreal injections of ranibizumab, laser treatment after each injection can improve the efficacy of ischemic CRVO treatment, improve patients’ visual acuity, inhibit vitreous inflammation, and reduce recurrence.