视网膜静脉阻塞继发黄斑水肿患者房水中细胞因子的检测及相关治疗的疗效评价

Detection of cytokines in aqueous humor of patients with secondary macular edema caused by retinal vein occlusion and evaluation of related treatment efficacy

目的通过采集视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者的房水,检测并分析眼内液中炎症因子及血管内皮生长因子的浓度,进而选择眼内注射药物的类型,比较并分析通过眼内液指导精准治疗与单纯雷珠单抗治疗的疗效差异。方法选取2021年11月至2023年3月就诊于蚌埠医科大学第一附属医院眼科,并确诊为RVO-ME的患者共40例(40眼),分为两组:精准治疗组(根据房水中炎症因子或血管内皮生长因子较正常值的浓度差异,选择注射地塞米松玻璃体内植入剂或雷珠单抗或联合治疗)和雷珠单抗组(不进行房水的抽取检测,选择单纯雷珠单抗治疗),随访并记录两组患者治疗前后1个月、2个月、3个月、6个月时的黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA);记录随访期间内注药次数、眼压及其他不良事件。结果精准治疗组平均注药次数为(2.55±0.83)次,雷珠单抗组平均注药次数为(3.45±1.05)次,两组平均注药次数相比差异有统计学意义(P<0.05);同时,与治疗前相比,精准治疗组和雷珠单抗组治疗后1个月、2个月、3个月、6个月患者CMT、BCVA均降低,差异均有统计学意义(P<0.05);术后1个月、2个月、3个月、6个月精准治疗组CMT、BCVA(Log MAR)与雷珠单抗组相比,差异无统计学意义(P>0.05)。在治疗期间,两组患者均未发生高眼压、眼内感染、视网膜出血等并发症。结论眼内液细胞因子浓度精准治疗RVO-ME和玻璃体腔内注射雷珠单抗治疗RVO-ME在改善视力,减轻黄斑水肿方面是安全有效,但精准治疗能减少患者注药次数,减轻经济负担。

Objective To collect aqueous humor from patients with retinal vein occlusion secondary macular edema(RVO-ME),detect and analyze the concentration of inflammatory factors and vascular endothelial growth factor in the intraocular fluid,and then select the type of intraocular injection drugs,and compare and analyze the therapeutic effect difference between the precision treatment guided by intraocular fluid and the ranibizumab monotherapy.Methods A total of 40 patients(40 eyes)diagnosed with RVO-ME from November 2021 to March 2023 were selected from the Ophthalmology Department of the First Affiliated Hospital of Bengbu Medical University and divided into two groups:Precision treatment group:Based on the difference in the concentration of inflammatory factors or vascular endothelial growth factor in aqueous fluid compared with normal values,the patients were selected for injection of dexamethasone intravitreal implant,ranibizumab,or combination treatment.Ranibizumab group:No aqueous humor sampling was performed,and ranibizumab monotherapy was selected.The central macular foveal thickness(CMT)and best-corrected visual acuity(BCVA)were followed up and recorded at 1,2,3 and 6 months before and after treatment in both groups.We then recorded the number of injections,intraocular pressure and other adverse events during follow-up.Results The average number of injections in the precision treatment group was 2.55±0.83,and that of the Ranibizumab group was 3.45±1.05.There was a statistically significant difference between the two groups(P<0.05).Compared with before treatment,CMT decreased and BCVA increased in both groups at all follow-up time points,with statistical significance(P<0.05).There was no significant difference in CMT and BCVA(LogMAR)between the two groups at any follow-up time point(P>0.05).During the treatment period,no complications such as intraocular hypertension,intraocular infection,or retinal hemorrhage occurred in either group.Conclusion Both accurate treatment for RVO-ME precision therapy guided by intraocular fluid cytokine concentrations and intravitreal injection of ranibizumab are safe and effective in improving visual acuity and alleviating macular edema.The precision treatment approach can reduce the number of injections required for patients,potentially reducing the economic burden compared to ranibizumab monotherapy.