雷珠单抗治疗非感染性葡萄膜炎继发黄斑水肿的临床研究

Therapeutic effect of intravitreal injection of ranibizumab on non-infectious uveitis secondary to macular edema

目的评估玻璃体腔注射雷珠单抗治疗非感染性葡萄膜炎继发黄斑水肿(Uveitis-related Cystoid Macular Edema,UC-ME)的临床疗效。方法选取2016年9月—2018年6月郑州大学第一附属医院收治的40例48眼非感染性葡萄膜炎继发黄斑水肿(Uveitis-related Cystoid Macular Edema,UC-ME)患者作为研究对象,依据治疗方法分为两组:糖皮质激素联合免疫抑制剂药物治疗,辅助玻璃体腔注射雷珠单抗治疗组(雷珠单抗组,22例,24眼)和仅用糖皮质激素联合免疫抑制剂药物治疗组(对照组,18例,24眼)。采用最佳矫正视力(Best Corrected Visual Acuity,BCVA)、荧光素眼底血管造影(Fundus Fluorescein Angiography,FFA)、光学相干断层扫描(Optical Correlation Tomography,OCT)及黄斑中心凹厚度(Central Macular Thickness,CMT)评估治疗6个月后临床疗效。结果治疗前两组患者的BCVA、FFA、OCT及CMT之间的差异均无统计学意义(P>0.05),治疗后6个月与对照组相比,辅助玻璃体腔注射雷珠单抗组患者的最佳矫正视力有显著提高,差异有统计学意义(P<0.05),OCT检查显示黄斑中心凹厚度明显降低,差异具有统计学意义(P<0.05);和治疗前相比,治疗后6个月两组患者最佳矫正视力有明显提高,差异具有统计学意义(P<0.05),OCT检查显示黄斑中心凹厚度明显降低,差异具有统计学意义(P<0.05)。荧光素眼底血管造影显示:治疗的40例48眼中,均未发现新的出血点及渗漏,也没有形成新的新生血管;其中26例患者32眼黄斑部渗漏病变,相较治疗前范围显著减小,另外14例患者16眼黄斑区已不显示渗漏病变。雷珠单抗治疗组患者治疗的总有效率(91.67%)高于对照组(75.00%),差异有统计学意义(P<0.05)。结论玻璃体腔内注射雷珠单抗药物对辅助治疗非感染性葡萄膜炎继发黄斑部水肿有较好的治疗效果,能帮助患者更好恢复视力。

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab in the treatment of non-infectious uveitis secondary to macular edema.Methods Forty patients with 48 eyes with non-infectious uveitis secondary to macular edema admitted to our hospital from September 2016 to June 2018 were enrolled in the study.They were divided into two groups according to the treatment:glucocorticoid combined with immunosuppressant drug therapy,adjuvant vitreous injection of ranibizumab treatment group(radizumab group,n=22,24 eyes)and glucocorticoid combined immunosuppressant drug treatment group(control group,n=18,24 eyes).The clinical outcomes were evaluated after 6 months of treatment with best corrected visual acuity(BCVA),fluorescein fundus angiography(FFA),optical coherence tomography(OCT),and macular fovea thickness(CMT).Results There was no significant difference in BCVA,OCT,and CMT between the two groups before treatment(P>0.05).The BCVA of the ranibizumab group was significantly higher than that of the control group 6 months after treatment.The difference was statistically significant(P<0.05),and the CT examination showed a significant decrease in CMT.The difference was statistically significant(P<0.05).Compared with that before treatment,the BCVA of the two groups was significantly improved 6 months after treatment.The significance of learning(P<0.05),CMT decreased significantly,the difference was statistically significant(P<0.05).FFA examination:no new bleeding and leakage sites were found in 40 of the 48 eyes treated,and no new blood vessels were formed.Among them,26 patients had 32 cases of macular leakage,which was smaller than the pre-treatment range.In 14 patients,there were no leakage lesions in the macula of 16 eyes.The total effective rate of treatment in the ranibizumab treatment group was 91.67%(22/24)higher than that of the control group(75.00%,18/24),and the difference was statistically significant(P<0.05).Conclusion Intravitreal injection of ranibizumab has a good therapeutic effect on adjuvant treatment of non-infectious uveitis secondary to macular edema,which can help patients to better restore vision.