玻璃体注射抗VEGF类药物与糖皮质激素类药物治疗视网膜静脉阻塞继发黄斑水肿的研究进展

Research progress on anti-VEGF drugs and glucocorticaid drugs for the treatment of retinal vein occlusion-associated macular edema

目前治疗视网膜静脉阻塞继发黄斑水肿(retinal vein occlusion-macular edema,RVO-ME)的主要方式是玻璃体注射抗VEGF类药物和糖皮质激素类药物。地塞米松玻璃体内植入剂(Ozurdex)治疗RVO-ME在改善视力和降低黄斑中央厚度(central macular thickness,CMT)方面的临床疗效在1个月内优于抗VEGF药物,在3个月内两种药物的临床疗效无统计学差异,同时6个月内需要再次注射Ozurdex保持其良好疗效。当两类药物联合治疗时,无论以间隔注射或同时注射方案均能在降低注射频率的同时有相似甚至比单药治疗有更好的疗效。与此同时,玻璃体注射两类药物时会造成高眼压、并发性白内障、眼内炎、视网膜裂孔、玻璃体出血和角膜损害等眼部并发症。

Currently,the main therapeutic strategies for retinal vein occlusion-associated macular edema macular edema(RVO-ME)encompass intravitreal injections of anti-vascular endothelial growth factor(VEGF)agents and corticosteroids.The clinical efficacy of dexamethasone intravitreal implant(Ozurdex)for the treatment of RVO-ME in improving visual acuity and reducing central macular thickness(CMT)is superior to that of anti-VEGF drugs at 1 month,and there is no statistically significant difference in clinical efficacy between the two drug types within 3 months post-injection,while Ozurdex needs to be re-injected within 6 months post-injection to maintainits favorable efficacy.When the two types of drugs are combined,either in a spaced or simultaneous injection regimen,they have similar or even better efficacy than monotherapy while reducing the frequency of injections.Meanwhile,intravitreal injections of these two types of drug can cause ocular complications such as high intraocular pressure,concurrent cataracts,endophthalmitis,retinal tears,vitreous hemorrhage,and corneal damage.