玻璃体腔注射雷珠单抗治疗缺血型和非缺血型视网膜中央静脉阻塞继发黄斑水肿一年疗效对比观察

摘要

目的 对比观察缺血型和非缺血型视网膜中央静脉阻塞(CRVO)继发黄斑水肿(ME)的1年疗效.方法 回顾性研究.临床确诊为CRVO继发ME的88例患者88只眼纳入研究.所有患眼均采用早期治疗糖尿病视网膜病变研究视力表检测最佳矫正视力(BCVA);光相干断层扫描测量其黄斑中心凹视网膜厚度(CRT)及黄斑区水肿容积.88例88只眼中,非缺血型、缺血型CRVO各为44例44只眼,并以此分为非缺血型组、缺血型组.两组患者年龄(t=o.650,P=0.517)、性别(x2=0.436,P=0.509)比较,差异无统计学意义.与缺血型组比较,非缺血型组CRT明显降低(t=-2.291,P=0.024),黄斑区水肿容积明显减小(t=-2.342,P=-0.022).所有患眼均行连续3次玻璃体腔注射雷珠单抗治疗,此后按需重复注射.ME消退不明显者同时联合曲安奈德注射治疗;存在周边视网膜无灌注区者联合周边视网膜激光光凝治疗.治疗后随访观察1年,统计患眼玻璃体腔注药次数.对比分析两组患眼治疗后BCVA、CRT及黄斑区水肿容积的变化.结果 1年随访期内,88只眼注射次数1～10次,平均注射次数为(4.51±2.33)次.缺血型组、非缺血型组注射次数分别为(4.55±1.59)、(4.48±2.91)次.两组平均注射次数比较,差异无统计学意义(t=0.136,P=0.892).缺血型组联合曲安奈德注射次数、激光治疗次数较非缺血型组明显增多,差异有统计学意义(t=3.729、9.512,P＜0.001).末次随访时,与缺血型组比较,非缺血型组患眼BCVA提高(t=8.128),CRT降低(t=-7.029),黄斑区水肿容积减小(t=-7.213),差异均有统计学意义(P＜0.001).结论 与缺血型CRVO继发ME比较,玻璃体腔注射雷珠单抗治疗非缺血型CRVO继发ME联合曲安奈德注射和激光治疗次数更少,视力提高更多,黄斑水肿消退更好.%Objective To compare the one year efficacy of intravitreal injection with ranibizumb for macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO).Methods A total of 88 patients (88 eyes) with ME secondary to CRVO were enrolled in this retrospective study.The best corrected visual acuity (BCVA) was detected by the Early Treatment Diabetic Retinopathy Study Chart.The optical coherence tomography was used to measure the foveal retinal thickness (CRT) and macular edema volume.The patients were divided into non-ischemic group and ischemic group,44 eyes of 44 patients in each group.There was no significant differences in age (t=0.650,P=0.517) and gender (x2=0.436,P=0.509) between the two groups.Compared with the ischemic group,the CRT was significantly decreased in the non-ischemic group (t=-2.291,P=0.024),and the edema volume in the macular area was significantly reduced (t=-2.342,P=0.022).All eyes were treated with continuous intravitreal injection of ranibizumab three times,and repeated injections were performed as needed.The patients without obvious ME regression after treatment were combined with triamcinolone acetonide injection.The patients with peripheral retinal non-perfusion area were combined with peripheral retinal laser photocoagulation.The follow-up was 1 year.The number of injections was counted.The changes of BCVA,CRT and edema volume in the macular area were compared between the two groups.Results During the 1-year follow-up period,88 eyes were injected 1 to 10 times,with the mean of 4.51 ±2.33.The number of injections in the ischemic group and non-ischemic group were 4.55± 1.59 and 4.48 ± 2.91,respectively.There was no significant difference in the average number of injections between the two groups (t=0.136,P=0.892).The number of acetonide injections and laser treatment in the ischemic group was significantly higher than that in the non-ischemic group (t=3.729,9.512;P＜0.001).At the last follow-up,compared with the ischemic group,the BCVA was increased (t=8.128),the CRT was decreased (t=-7.029) and the edema volume in the macular area was decreased (t=-7.213) in the non-ischemic group (P＜ 0.001).Conclusion Compared with ME secondary to ischemic CRVO,intravitreal injection of ranibizumab for ME secondary to non-ischemic CRVO has the better outcome of vision improvement and edema regression as well as less fiequent of acetonide injections and laser treatment.