玻璃体腔注射雷珠单抗联合曲安奈德治疗视网膜静脉阻塞继发黄斑水肿对黄斑区视网膜微循环的影响

Effects of intravitreal injection of ranibizumab combined with triamcinolone acetonide on macular retinal microcirculation in RVO-ME

目的探究玻璃体腔注射雷珠单抗联合曲安奈德用于视网膜静脉阻塞(RVO)继发黄斑水肿(ME)对黄斑区视网膜微循环的影响。方法回顾性分析2022年1月至2023年9月在浙江大学医学院附属金华医院就诊的RVO-ME患者临床资料,观察组应用玻璃体腔注射雷珠单抗联合曲安奈德治疗方案(197例,患眼229眼);对照组应用玻璃体腔注射雷珠单抗治疗方案(183例,患眼211眼),比较治疗前、治疗3个月后2组患者的视力相关参数、黄斑区视网膜微循环血流灌注参数、眼部血流动力学参数以及治疗期间的不良反应发生情况。结果治疗3个月后,2组患者的最佳矫正视力(BCVA)、中心视网膜厚度(CMT)、黄斑中心凹无血管区(FAZ)面积、FAZ周长较治疗前好转,且观察组[BCVA(0.43±0.09)、CMT(280±22)μm、FAZ面积(0.21±0.06)mm^(2)、FAZ周长(2.11±0.26)mm]低于对照组[BCVA(0.51±0.11)、CMT(301±30)μm、FAZ面积(0.27±0.07)mm^(2)、FAZ周长(2.29±0.20)mm](t=8.375、8.447、9.675、8.090,P均<0.05);2组患者浅表毛细血管丛(SCP)血流密度、深层毛细血管丛(DCP)血流密度、视网膜静脉收缩期峰值流速(PSV)、舒张末期流速(EDV)较治疗前提高,且观察组[SCP血流密度(46±3)%、DCP血流密度(47.3±3.8)%、PSV(24.4±1.4)cm/s、EDV(8.3±1.4)cm/s]高于对照组[SCP血流密度(44±3)%、DCP血流密度(46.0±3.5)%、PSV(23.4±1.3)cm/s、EDV(7.9±1.3)cm/s](t=5.120、3.753、6.673、3.122,均P<0.05)。2组患者的眼压、阻力指数(RI)和臂视网膜时间(ART)治疗前后差异无统计学意义(t=0.997、0.001、0.821,P>0.05)。治疗期间,观察组的不良反应发生率(6.6%)高于对照组(2.1%)(χ^(2)=4.324,P<0.05)。结论玻璃体腔注射雷珠单抗联合曲安奈德能够有效治疗RVO-ME患者,促进患者视力恢复,改善黄斑区视网膜微循环和眼部血流动力学,具有较好的安全性。

Objective To explore the effects of intravitreal injection of ranibizumab combined with triamcinolone acetonide on macular retinal microcirculation in macular edema(ME)secondary to retinal vein occlu-sion(RVO).Methods A retrospective analysis was conducted on the clinical data of RVO-ME patients who were treated in Affiliated Jinhua Hospital,Zhejiang University School of Medicine from January 2022 to September 2023.The observation group was treated with intravitreal injection of ranibizumab combined with triamcinolone acetonide(n=197,eyes=229),while the control group was treated with intravitreal injection of ranibizumab alone(n=183,eyes=211).The vision-related parameters,retinal microcirculation perfusion parameters in the macular area,ocular hemodynamic parameters,and the occurrence of adverse reactions during treatment were compared between the two groups before treatment and 3 months after treatment.Results Three months after treatment,the best-corrected visual acuity(BCVA),central macular thickness(CMT),foveal avascular zone(FAZ)area,and FAZ perimeter in both groups improved significantly compared to before treatment.Moreover,the observation group had lower BCVA(0.43±0.09),CMT(280±22)μm,FAZ area(0.21±0.06)mm2,and FAZ perimeter(2.11±0.26)mm compared to the control group[BCVA(0.51±0.11),CMT(301±30)μm,FAZ area(0.27±0.07)mm2,FAZ perimeter(2.29±0.20)mm](t=8.375,8.447,9.675,8.090,all P<0.05).The blood flow density of superficial capillary plexus(SCP),deep capillary plexus(DCP),peak systolic velocity(PSV)of retinal veins,and end-diastolic velocity(EDV)were significantly increased in both groups compared to before treatment;Furthermore,the observation group showed higher values in SCP blood flow density(46±3)%,DCP blood flow density(47.3±3.8)%,PSV(24.4±1.4)cm/s,and EDV(8.3±1.4)cm/s compared to the control group[SCP blood flow density(44±3)%,DCP blood flow density(46.0±3.5%),PSV(23.44±1.33)cm/s,EDV(7.9±1.3)cm/s](t=5.120,3.753,6.673,3.122,all P<0.05).There was no statistically significant difference in intraocular pressure,resistance index(RI),and arm-retina time(ART)between the two groups before and after treatment(t=0.997,0.001,0.821,all P>0.05).During the treatment period,the incidence of adverse reactions in the observation group was significantly higher than that in the control group(6.6%vs 2.1%,χ^(2)=4.324,P<0.05).Conclusion Intravitreal injection of ranibizumab combined with triamci-nolone acetonide can effectively treat patients with RVO-ME,promote the recovery of visual acuity,significantly improve the retinal microcirculation in the macular area and ocular hemodynamics,with good safety.