抗血管内皮生长因子药物治疗合并玻璃体积血的X连锁视网膜劈裂症疗效分析

Anti-vascular endothelial growth factor treatment in X-linked retinoschisis with vitreous hemorrhage

目的观察玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗X连锁视网膜劈裂症(XLRS)合并玻璃体积血(VH)的疗效。方法回顾性临床研究。2016年3月1日至2022年4月1日于首都医科大学附属北京同仁医院眼科检查确诊的XLRS合并VH患者18例19只眼纳入研究。患者均为男性;年龄(7.05±3.85)岁。所有患眼均行最佳矫正视力(BCVA)、广角眼底彩色照相检查。BCVA检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。依据是否接受玻璃体腔注射雷珠单抗(IVR)治疗,将患者分为注药组、观察组,分别为10例11只眼、8例8只眼。注药组患眼玻璃体腔注射10 mg/ml的雷珠单抗0.025 ml(含雷珠单抗0.25 mg)。治疗后随访时间(24.82±20.77)个月。观察注药组患眼治疗后VH吸收时间、视力变化以及并发症发生情况。VH前后、IVR治疗前后BCVA比较采用配对样本t检验;注药组与观察组之间VH吸收时间比较采用独立样本t检验。结果VH前后患眼logMAR BCVA分别为0.73±0.32、1.80±0.77;VH后BCVA显著降低,差异有统计学意义(t=-3.620,P=0.006)。注药组患眼VH后、IVR治疗后logMAR BCVA分别为1.87±0.55、0.62±0.29;IVR治疗后BCVA显著提高,差异有统计学意义(t=6.684,P<0.001)。治疗前后均有BCVA记录5只眼,VH后、IVR治疗后logMAR BCVA分别为0.58±0.31、0.48±0.20,差异无统计学意义(t=1.000,P=0.374);治疗后BCVA提高1只眼,无变化4只眼。观察组8只眼中,VH前、VH吸收后均有BCVA记录5只眼。VH前、VH吸收后患眼logMAR BCVA分别为0.88±0.28、0.90±0.26,差异无统计学意义(t=-1.000,P=0.374);VH吸收后,BCVA无变化、降低分别为4、1只眼。注药组、观察组患眼VH吸收时间分别为(1.80±1.06)、(7.25±5.04)个月;注药组患眼VH吸收时间较观察组显著缩短,差异有统计学意义(t=-3.005,P=0.018)。多因素线性回归分析结果显示,是否IVR治疗与VH吸收时间显著相关(B=-6.66,95%可信区间-10.93~-2.39,t=-3.40,P=0.005)。注药组患眼中,IVR治疗后发生再积血者1只眼;行玻璃体切割手术(PPV)1只眼。观察组8只眼中,发生再积血2只眼;行PPV 1只眼。注药组患眼发生再积血和行PPV的比例更低,但差异无统计学意义(P=0.576、1.000)。并发症方面,注药组出现少量结膜下出血2只眼,轻微角膜上皮点状损伤1只眼,均在短期内自行恢复。注药组中有IVR治疗前后广角眼底彩色照相资料9只眼,治疗后周边劈裂范围均无明显改变。所有患眼均未出现明显机化增生以及感染性眼内炎、视网膜脱离、黄斑裂孔、并发性白内障、继发性青光眼等严重并发症,且无全身相关并发症。结论玻璃体腔注射抗VEGF药物治疗可以促进XLRS患者VH吸收;对周边视网膜劈裂无明显影响。

Objective To review the outcome of intravitreous anti-vascular endothelial growth factor(VEGF)treatment in patients with X-linked retinoschisis(XLRS)complicated with vitreous hemorrhage(VH).Methods A retrospective clinical study.From March 1,2016 to April 1,2022,18 patients(19 eyes)diagnosed with XLRS complicated with vitreous hemorrhage in Beijing Tongren Hospital,Capital Medical University of Eye Center were included.All the patients were male,with a median age of 7.05±3.8 years.Best corrected visual acuity(BCVA)and wide-angle fundus photography were performed in all the patients.BCVA was carried out using international standard visual acuity chart,and converted into logarithm of minimum resolution angle(logMAR)in statistics analysis.According to whether the patients received intravitreal injection of ranibizumab(IVR),the patients were divided into injection group and observation group,with 11 eyes in 10 cases and 8 eyes in 8 cases,respectively.In the injection group,0.025 ml of 10 mg/ml ranibizumab(including 0.25 mg of ranibizumab)was injected into the vitreous cavity of the affected eye.Follow-up time after treatment was 24.82±20.77 months.The VH absorption time,visual acuity changes and complications were observed in the injection group after treatment.Paired sample t test was used to compare BCVA before and after VH and IVR treatment.Independent sample t test was used to compare the VH absorption time between the injection group and the observation group.Results LogMAR BCVA before and after VH were 0.73±0.32 and 1.80±0.77,respectively.BCVA decreased significantly after VH(t=-3.620,P=0.006).LogMAR BCVA after VH and IVR were 1.87±0.55 and 0.62±0.29,respectively.BCVA was significantly improved after IVR treatment(t=6.684,P<0.001).BCVA records were available in 5 eyes before and after IVR,and the BCVA values after VH and IVR were 0.58±0.31 and 0.48±0.20,respectively,with no statistically significant difference(t=1.000,P=0.374).BCVA increased in 1 eye and remained unchanged in 4 eyes after treatment.BCVA records were available in 5 eyes before VH and after VH absorption in the 8 eyes of the observation group.LogMAR BCVA before VH and after VH absorption were 0.88±0.28 and 0.90±0.26,respectively,with no significant difference(t=-1.000,P=0.374).After VH absorption,BCVA remained unchanged in 4 eyes and decreased in 1 eye.The absorption time of VH in the injection group and the observation group were 1.80±1.06 and 7.25±5.04 months,respectively.The absorption time of VH was significantly shorter in the injection group than in the observation group,the difference was statistically significant(t=-3.005,P=0.018).Multivariate linear regression analysis showed that IVR treatment was significantly correlated with VH absorption time(B=-6.66,95%confidence interval-10.93--2.39,t=-3.40,P=0.005).In the injection group,VH recurrence occurred in 1 eye after IVR treatment.Vitrectomy(PPV)was performed in one eye.In the 8 eyes of the observation group,VH recurrence occurred in 2 eyes,subsequent PPV in 1 eye.The rate of VH recurrence and PPV was lower in the injection group,however,the difference was not statistically significant(P=0.576,1.000).In terms of complications,minor subconjunctival hemorrhage occurred in 2 eyes and minor corneal epithelial injury occurred in 1 eye in the injection group,and all recovered spontaneously within a short time.In the injection group,9 eyes had wide-angle fundus photography before and after IVR treatment.There was no significant change in the range of peripheral retinoschisis after treatment.No obvious proliferative vitreoretinopathy,infectious endophthalmitis,retinal detachment,macular hole,complicated cataract,secondary glaucoma or other serious complications were found in all the treated eyes,and there were no systemic complications.Conclusion Intravitreous anti-VEGF treatment may accelerate the absorption of vitreous hemorrhage in patients with XLRS.No impact is found regarding to the peripheral retinoschisis.