玻璃体腔注射雷珠单抗联合地塞米松缓释剂治疗视网膜静脉阻塞继发黄斑水肿

Combination of Ranibizumab and Dexamethasone intravitreal implant for macular edema secondary to retinal vein occlusion

目的:比较玻璃体腔注射地塞米松缓释剂(Ozurdex)联合雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)与单独使用雷珠单抗治疗的疗效及安全性的差异。方法:选取2020-06/2022-12就诊于我院经眼底血管荧光造影检查确诊为非缺血型RVO-ME的患者,所有患者先行玻璃体腔注射0.5 mg雷珠单抗注射液,2 wk后复查黄斑中心凹视网膜厚度(CRT)≥300μm的42例42眼患者纳入研究,随机分为联合治疗组(21例21眼,即时给予玻璃体腔内注射地塞米松缓释剂)及单药治疗组[21例21眼,仍继续按3+按需(PRN)方式行雷珠单抗注射治疗]。观察治疗前及分组治疗后2 wk,1、2、3、4、5、6 mo的最佳矫正视力(BCVA)、CRT及眼压的改变,并观察眼部及全身并发症的发生情况。结果:分组治疗后2 wk,1、2、3、4、5、6 mo,两组患者BCVA及CRT的改善程度较治疗前显著好转(均P<0.01);治疗后2、3 mo,两组间BCVA及CRT比较有差异(均P<0.05),治疗后2 mo时联合治疗组BCVA字母数增加最明显。单药治疗组黄斑水肿平均复发时间为1.45±0.53 mo,雷珠单抗注射平均4.21±0.78次,两组患者治疗后均未见严重并发症。联合治疗组最常见的并发症为结膜下出血和眼压升高,局部使用降压药后眼压可控制,没有患者需接受抗青光眼及白内障手术。结论:玻璃体腔注射地塞米松缓释剂联合雷珠单抗治疗RVO-ME与单独使用雷珠单抗治疗相比,能显著提高患者的视力,有效减轻黄斑水肿,疗效持续时间长,可有效减少玻璃体腔注药次数。

AIM:To compare the differences in the efficacy and safety of combination of intravitreal dexamethasone(Ozurdex)and ranibizumab or monotherapy of ranibizumab in eyes with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS:Patients diagnosed with non-ischemic RVO-ME by fluorescein fundus angiography in our hospital from June 2020 to December 2022 were selected.All patients were initially treated with intravitreal injection of ranibizumab(0.5 mg),and 42 patients(42 eyes)who had central retinal thickness(CRT)≥300μm after 2 wk were included.They were randomly divided into combined treatment group and monotherapy group.The combined treatment group(21 eyes)received Ozurdex intravitreal injection immediately,while the monotherapy group(21 eyes)was treated with ranibizumab intravitreal injection by 3+pro re nata(PRN).The changes of best corrected visual acuity(BCVA),CRT,and intraocular pressure before and at 2 wk,1,2,3,4,5,and 6 mo after treatment were recorded,and the ocular or systemic complications were observed.RESULTS:The BCVA and CRT of all patients at 2 wk,1,2,3,4,5,and 6 mo after treatment were significantly better than those before treatment(all P<0.01).There were statistical significance in the BCVA and CRT between two groups at 2 and 3 mo after treatment(all P<0.05).The most significant increase of BCVA in the combined treatment group occurred at 2 mo after treatment.The mean recurrence time of macular edema in the monotherapy group was 1.45±0.53 mo,with 4.21±0.78 injection times of ranibizumab.None of the patients showed serious complications after treatment.The most common complications in the combined treatment group were subconjunctival hemorrhage and elevated intraocular pressure,which were manageable with topical ocular hypotensive agents,and no patient required antiglaucoma or cataract surgery.CONCLUSION:Compared with monotherapy of ranibizumab,intravitreal injection of dexamethasone combined with ranibizumab can significantly improve the visual acuity and effectively reduce the macular edema in the treatment of RVO-ME,with a long duration of efficacy and less intravitreal injection of drugs.