雷珠单抗治疗病理性近视继发脉络膜新生血管不同给药方案疗效比较

Comparative study on the efficacy of different dosage regimens of Ranibizumab in the treatment of choroid neovascularization secondary to pathological myopia

目的:观察雷珠单抗不同给药方案治疗病理性近视继发脉络膜新生血管(PM-CNV)的疗效,并探讨影响再治疗的相关因素。方法:回顾性分析2015-01/2020-01于我院确诊为PM-CNV并进行玻璃体腔注射雷珠单抗治疗的患者42例43眼的病历资料,根据不同给药方案分为A组(3+PRN,22例22眼)和B组(1+PRN,20例21眼)。随访12mo,观察并比较两组患者最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、脉络膜新生血管(CNV)变化情况,并比较两组患者玻璃体腔注药次数、初始治疗后再治疗率和复发率情况,分析影响再治疗的相关因素。结果:治疗后1、3、6、12mo,两组患者BCVA(LogMAR)、CMT和CNV厚度均较治疗前明显改善(P<0.05)。随访12mo,A组和B组患者玻璃体腔注药次数分别为3(3,4)、2(1,3)次(P<0.001);初始治疗后再注药次数分别为0(0,1)、1(0,2)次(P=0.061);两组患者再治疗率(32%vs 57%)、复发率(14%vs 29%)均无差异(P=0.095、0.281)。此外,1+PRN给药方案、女性、基线CMT>300μm和基线CNV面积>1.0mm~2均是影响再治疗的相关因素。结论:玻璃体腔注射雷珠单抗1+PRN和3+PRN给药方案均能有效改善PM-CNV患者的视力预后和解剖结构,但1+PRN给药方案较3+PRN给药方案的注药次数更少,降低了治疗风险和费用。

AIM:To observe the efficacy of different dosage regimens of ranibizumab in the treatment of choroid neovascularization secondary to pathological myopia(PM-CNV),and to explore the related factors affecting retreatment.METHODS:The medical records of 42 patients(43 eyes)diagnosed with PM-CNV in our hospital from January 2015 to January 2020 and treated with intravitreal injection of ranibizumab were retrospectively analyzed.According to different dosage regimens,they were divided into group A(3+PRN,22 cases with 22 eyes)and group B(1+PRN,20 cases with 21 eyes).Followed up for 12 mo,the changes of best corrected visual acuity(BCVA),central macular thickness(CMT)and choroidal neovascularization(CNV)were observed and compared between the two groups.The times of intravitreal injection,retreatment rate and recurrence rate after initial treatment were compared between the two groups,and the related factors affecting retreatment were analyzed.RESULTS:At 1,3,6 and 12 mo,the BCVA(LogMAR),CMT and CNV thickness in the two groups were significantly improved compared with those before treatment(P<0.05).During the 12 mo follow-up,the times of intravitreal injection in group A and group B were 3(3,4)and 2(1,3),respectively(P<0.001),and the times of reinjection after the initial treatment were 0(0,1)and 1(0,2),respectively(P=0.061).There was no difference in retreatment rate(32%vs 57%)and recurrence rate(14%vs 29%)between the two groups(P=0.095,0.281).In addition,1+PRN treatment regimen,female,baseline CMT>300μm and baseline CNV area>1.0 mm~2 were all related factors affecting retreatment.CONCLUSION:Intravitreal injection of ranibizumab 1+PRN and 3+PRN can both effectively improve the visual prognosis and anatomical structure of PM-CNV patients,but the 1+PRN treatment has less injection times than the 3+PRN treatment,which reduces the risk and cost of treatment.