阿柏西普联合阈值下激光治疗缺血型视网膜分支静脉阻塞继发黄斑水肿的临床观察

Clinical Evaluation on Joint Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion with Intravitreal Aflibercept and Subthreshold Laser

目的观察视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿(macular edema,ME)的患者经阿柏西普联合阈值下视网膜激光治疗的临床疗效。方法回顾性分析2017年1月至2020年1月,BRVO-ME患者62例62只眼的临床资料,根据治疗方法不同分为两组,分别为联合治疗组患者30例30只眼,2018年5月至2020年1月接受阿柏西普联合阈值下视网膜光凝术治疗;对照组患者32例32只眼,2017年1月至2018年12月仅采用阈值下视网光凝术治疗;所有患者视网膜缺血区经播散激光光凝治疗。比较分析两组患者治疗前、治疗后1个月、3个月、6个月和12个月的最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心视网膜厚度(central macular retinal thickness,CRT)以及治疗前、治疗后6个月的眼底荧光血管造影检查(fundus fluorescence in angiography,FFA)结果,评估疗效。结果治疗前联合治疗组和对照组的CRT、BCVA比较,差异无统计学意义(P>0.05)。治疗后1个月和3个月,两组患者的CRT、BCVA与治疗前比较,差异均具有统计学意义(P<0.05)。治疗后6个月和12个月,两组CRT、BCVA与同组治疗后3个月比较,差异无统计学意义(P>0.05)。治疗后1个月、3个月、6个月,两组间CRT比较,差异均具有统计学意义(P<0.05);治疗后12个月,两组间CRT比较,差异无统计学意义(P>0.05)。而联合治疗组治疗后1~12个月BCVA均明显高于对照组(P<0.05)。结论阈值下激光光凝和阿柏西普联合阈值下激光光凝治疗BRVO-ME,均可降低黄斑水肿厚度,改善视力预后;阈值下激光光凝和阿柏西普联合阈值下激光光凝疗效明显优于单独阈值下激光治疗。

Objective To evaluate the clinic effect to treat macular edema(ME)secondary to retinal branch vein occlusion(BRVO)jointly with intravitreal Aflibercept and subthreshold laser(SLT).Methods Totally 62 patients(62 eyes)of ME secondary to retinal BRVO treated during the period from Jan.2017 to Jan.2020 were selected and divided into two groups by treating methods:the combination treatment group(30 patients and 30 eyes)and control group(32 patients and 32 eyes).The patients in the combination treatment group were given intravitreal Aflibercept and SLT over the period from May 2018 to Jan.2020,and those in the control group only SLT over the period from Jan.2017 to Dec.2018.All the patients were treated with scatter laser photocoagulation in the non-perfusion area of retina.To evaluate the efficacy,the BCVA and central macular retinal thickness(CRT)were compared and analyzed between the two groups before the treatment and 1,3,6 and 12 months after the treatment respectively,and the results of fundus fluorescence angiography before and 6 months after the treatment were also compared.Results There was no statistically significant difference in CRT and BCVA between the combination treatment group and control group(P>0.05).For both groups,the CRT and BCVA changed dramatically 1 month and 3 months after the treatment(P<0.05).For each group,the difference between the 6-month or 12-month CRT and BCVA and 3-month CRT and BCVA was not significant(P>0.05).The difference between the two groups in CRT was significant 1,3 and 6 months after the treatment(P<0.05),but the difference was not great 12 months after the treatment(P>0.05).Nevertheless,the BCVA was greater in the combination treatment group than in the control group 1-12 months after the treatment(P<0.05).Conclusions Both the sole use of SLT and the combination of SLT with intravitreal Aflibercept will reduce macular edema thickness and improve visual prognosis in treating the BRVO secondary to ME,but the efficacy of the combined treatment is apparently better.