地塞米松玻璃体内植入与雷珠单抗治疗视网膜静脉阻塞的疗效比较

Therapeutic effects of intravitreal implantation of Dexamethasone and Ranibizumab in the treatment of retinal vein occlusion

目的:比较地塞米松玻璃体内植入与玻璃体注射雷珠单抗治疗视网膜静脉阻塞(RVO)的疗效。方法:回顾性研究。选取本院40例ROV患者,根据治疗方式不同分为2组,A组采用地塞米松玻璃体内植入进行治疗,B组采用玻璃体腔注射雷珠单抗,比较两组患者治疗前后眼压、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、浅层血管复合体(SVC)层、深层血管复合体(DVC)层、脉络膜层与脉络膜毛细血管层黄斑区血流密度(MVD)、黄斑中心凹无血管区(FAZ)面积,记录复发及不良反应情况。结果:两组患者治疗12mo BCVA、CMT均较治疗前得到明显改善(P<0.05),但两组间比较无显著差异(P>0.05);治疗后,两组间SVC层、脉络膜层、脉络膜毛细血管层MVD比较均无显著差异(P>0.05),A组DVC层MVD显著大于B组(P<0.05);两组患者治疗前后浅层与深层FAZ面积比较均无显著差异(P>0.05);两组患者治疗后结膜下出血、异物感发生率比较均无显著差异(P>0.05),A组高眼压发生率明显高于B组(P<0.05);两组患者黄斑水肿(ME)复发率比较无显著差异(P>0.05),但A组平均复发时间明显长于B组(P<0.05)。结论:相较于玻璃体腔注射雷珠单抗,地塞米松玻璃体内植入可更好增加DVC层MVD,疗效维持时间更长,但应注意高眼压不良反应风险。

AIM:To compare the therapeutic effects of intravitreal implantation of dexamethasone and ranibizumab in the treatment of retinal vein occlusion(RVO).METHODS:Retrospective study.A total of 40 patients with ROV were selected,and they were randomly divided into 2 groups according to different treatment.Patients in group A were treated with intravitreal implantation of dexamethasone,while patients in group B were treated with intravitreal injection of ranibizumab.Intraocular pressure,central macular thickness(CMT),best corrected visual acuity(BCVA),superficial vascular complex(SVC)layer,dorsal vasculature complex(DVC)layer,macular vascular density(MVD)of choroid layer and choroidal capillary layer and foveal avascular area(FAZ)of the patients in both groups were measured and compared before and after treatment.Recurrence and adverse reactions were recorded.RESULTS:After treatment for 12mo,the BCVA and CMT of the 2 groups were significantly improved(P<0.05),but there was no significant difference between the 2 groups(P>0.05).After treatment,there was no significant difference in MVD of SVC layer,choroid layer or choroidal capillary layer between the 2 groups(P>0.05),but the MVD of DVC layer in group A was significantly greater than that in group B(P<0.05).There was no significant difference in superficial and deep FAZ areas between the two groups before and after treatment(P>0.05).There was no significant difference in the incidence rates of subconjunctival hemorrhage and foreign body sensation between the 2 groups(P>0.05),but the incidence of intraocular hypertension in group A was significantly higher than that in group B(P<0.05).There was no significant difference in the recurrence rate of macular edema(ME)between the two groups(P>0.05),but the average recurrence time of group A was significantly longer than that of group B(P<0.05).CONCLUSION:Intravitreal implantation of dexamethasone can better increase the MVD of DVC layer and maintain the effect for a longer time than the intravitreal injection of ranibizumab,but there is a higher risk of intraocular hypertension and other adverse reactions.