玻璃体腔注射不同药物联合激光治疗视网膜静脉阻塞合并黄斑水肿的疗效比较

Effects of intravitreous injection of different drugs combined with laser photocoagulation for macular edema secondary to retinal vein occlusion

摘要:

目的：观察和分析玻璃体腔注射曲安奈德或康柏西普联合激光治疗视网膜静脉阻塞合并黄斑水肿的疗效。

方法：视网膜静脉阻塞合并黄斑水肿患者50例50眼，分为两组，分别注射曲安奈德和康柏西普，术后7d眼底激光对黄斑区进行局部光凝或格栅样光凝，分别在注药术后14d，1、3mo行最佳矫正视力、眼压、眼底检查、光学相干断层扫描检查，术后3mo行荧光素眼底血管造影检查，将各组各时间点术后检测结果与术前值进行比较，做出客观评价。

结果：两种治疗方式与治疗前相比，在注药术后14d，激光治疗后1、3mo视力均有不同程度的提高，其中曲安奈德组视力提高者分别为76%、80%、68%，康柏西普组视力提高者分别为88%、92%、88%； 两组治疗方式在各个时间段最佳矫正视力均有不同程度的提高，治疗后1mo最佳矫正视力最好； 与术前相比，两组治疗方式黄斑区厚度均有不同程度地降低，术前、术后14d，1、3mo黄斑区平均视网膜厚度曲安奈德组分别为557.5±150.9、 301.7±120.1、262.7±131.2、338.1±146.5μm，术前黄斑区厚度与术后有显著差异性，康柏西普组分别为569.4±135.9、282.3±133.5、259.5±116.4、307.8±122.6μm，术前黄斑区厚度与术后有统计学差异。

结论：曲安奈德或康柏西普玻璃体腔注射联合激光治疗视网膜静脉阻塞合并黄斑水肿疗效好，但康柏西普治疗效果更优、更安全、更有效。

Abstract:

AIM: To evaluate the effects and safety of intravitreal injection of triamcinolone acetonide(TA)or conbercept combined with macular laser grid photocoagulation in the treatment of macular edema secondary to retinal vein occlusion(RVO).

METHODS: Fifty cases(50 eyes)with macular edema secondary to retinal vein occlusion were selected and assigned to 2 groups: intravitreal injection of TA or conbercept, and laser photocoagulation after 7d. Best corrected visual acuity(BCVA), fundus examination, optical coherence tomography(OCT)and intraocular pressure(IOP)were examined before intravitreous injection and 14d, 1 and 3mo after laser, fundus fluorescein angiography(FFA)were examined 3mo after treatment. The postoperative results at each time point were compared with preoperative values.

RESULTS: Two kinds of treatment compared with preoperative, the BCVA all increased in various degrees. At 14d after intravitreous injection, 1 and 3mo after laser, the ratio of vision improved in TA group was 76%, 80%,68%, conbercept group was 88%, 92%, 88%, BCVA of two groups in each period all had varying degrees of increase than preoperative. The best BCVA acquired at 1mo after treatment. The macular thickness after treatment was significantly lower than preoperative in two groups. At preoperative, 14d, 1 and 3mo after treatment, the macular thickness in TA group was 557.5±150.9, 301.7±120.1, 262.7±131.2, 338.1±146.5μm; the macular thickness in conbercept group was 569.4±135.9, 282.3±133.5, 259.5±116.4, 307.8±122.6μm. The macular thickness of the two groups were significantly different between preoperative and postoperative.

CONCLUSION: The combination of intravitreous injection of TA or conbercept with macular laser grid photocoagulation can be an effective method in the treatment of macular edema secondary to RVO, conbercept treatment is more effective and security.