玻璃体腔注射Ranibizumab联合激光治疗BRVO继发黄斑水肿的观察

Intravitreal injection with Ranibizumab combined with laser therapy for macular edema caused by branch retinal vein occlusion

摘要:

目的：评价玻璃体腔注射ranibizumab(雷珠单抗)联合激光治疗视网膜分支静脉阻塞(branch retinal vein occlusion，BRVO)继发黄斑水肿(macular edema)的临床疗效。

方法：经眼底荧光血管造影(fundus fluorescence angiography，FFA)及光学相干断层扫描(optical coherence tomography，OCT)检查确诊为BRVO合并黄斑水肿的患者78例78眼，随机选取A组26例26眼，行黄斑部格栅光凝(grid laser photocoagulation，GLP)； B组26例26眼，先行黄斑部格栅光凝，1wk后再行玻璃体腔注射ranibizumab治疗； C组26例26眼，先行玻璃体腔注射ranibizumab治疗，1wk后再行黄斑部格栅光凝，三组黄斑水肿无显著性差异。对比分析三组治疗前，治疗后1wk，1及6mo患者最佳矫正视力(best corrected visual acuity，BCVA)、黄斑中心厚度(central macular thickness，CMT)的变化。

结果：治疗后1wk与治疗前相比：A组BCVA平均值、CMT平均值变化差异无统计学意义(P>0.05)； B、C组BCVA平均值提高，CMT平均值降低，差异具有统计学意义(P<0.05)； 组间比较BCVA变化、CMT变化差异具有显著统计学意义(P<0.01)。治疗后1，6mo与治疗前相比，三组BCVA平均值提高，CMT平均值降低，差异均具有显著统计学意义(P<0.01)； 组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后6mo与治疗后1mo相比，A、B组BCVA平均值、CMT平均值变化差异均无统计学意义(P>0.05)； C组BCVA平均值提高，CMT平均值降低，差异具有显著统计学意义(P<0.01)； 组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.01)。

结论：玻璃体腔注射Ranibizumab联合激光治疗可有效的减轻BRVO所致黄斑水肿，提升视力； 其作用较单纯GLP治疗起效更迅速、能更好的减轻黄斑水肿； 于黄斑格栅光凝治疗前先行玻璃体腔注射ranibizumab治疗效果更为确切、稳定性更强。

Abstract:

AIM:To investigate the efficacy of intravitreal ranibizumab combined with laser therapy in the treatment of macular edema caused by branch retinal vein occlusion(BRVO).

METHODS:There were 78 patients(78 eyes)who were diagnosed with macular edema caused by BRVO using fundus fluorescence angiography(FFA)and optical coherence tomography(OCT). Group A: randomly selected 26 cases(26 eyes)were given grid laser photocoagulation(GLP). Group B: randomly selected 26 cases(26 eyes)were given GLP first, and then received intravitreal ranibizumab 1wk later. Group C: randomly selected 26 cases(26 eyes)undergone intravitreal ranibizumab first, and then given GLP 1wk later. There was no significant difference in macular edema. We analyzed the changes in the best corrected visual activity(BCVA), central macular thickness(CMT)before and 1wk, 1,6mo after treatment.

RESULTS: Compared with before treatment, 1wk after treatment: mean value changes of BCVA and CMT were no significant difference in group A(P>0.05); mean value changes of BCVA was improved and mean value of CMT was decreased in groups B and C, the difference was statistically significant(P<0.05); BCVA and CMT changes between groups had statistical significance(P<0.01); After treatment 1, 6mo: compared with before treatment, mean BCVA was improved in three groups, mean CMT was lower, the differences were statistically significant(P<0.01); BCVA and CMT changes between groups were statistically significant(P<0.05); compared with 1mo after treatment, mean BCVA and CMT were no significant difference(P>0.05)between groups A and B after 6mo treatment; mean BCVA improved and CMT average value was decreased in group C, the difference was statistically significant(P<0.01); BCVA and CMT changes between groups were statistically significant(P<0.01).

CONCLUSION: Intravitreal injection ranibizumab combined laser therapy can effectively reduce BRVO induced macular edema, enhance vision acuity. Compared with GLP, combination therapy has more rapid onset of treatment, and reduce macular edema better; Intravitreal ranibizumab should be given in front of the GLP, and the treatment effect is more precise, more stability.