目的：探讨玻璃体内注射雷珠单抗联合577nm激光治疗视网膜静脉阻塞合并黄斑水肿的临床疗效。

方法：选取我院于2014-06/2017-03期间收治的视网膜静脉阻塞合并黄斑水肿患者64例64眼，其中视网膜中央静脉阻塞组患者40例40眼，视网膜分支静脉阻塞组患者24例24眼，均于玻璃体内注射0.5mg的雷珠单抗进行治疗，在注射后的第5～7d给予577nm的激光光凝治疗。同时期42例42眼单纯采用577nm激光光凝治疗的视网膜静脉阻塞合并黄斑水肿患者作为对照组。对比治疗前后各组患者相关指标的变化情况。

结果：视网膜分支静脉阻塞组重复注射的平均次数为1.71±0.79次，视网膜中央静脉阻塞组患者重复注射的平均次数为2.11±0.80次，所有需要重复注射的患者注射时间间隔均>30d。治疗1mo后随访时，视网膜分支静脉阻塞组患者中无视力下降者，而视网膜中央静脉阻塞组患者中出现视力下降者6例6眼，单纯激光治疗组14例14眼； 三组患者的最佳矫正视力(best corrected visual acuity，BCVA)分别为0.87±0.60、0.57±0.48和0.54±0.32，均显著优于治疗前(1.26±0.53、0.86±0.39、0.76±0.26)，差异均有统计学意义(P<0.05)。治疗前三组患者的黄斑中心凹视网膜厚度(central macular thickness，CMT)分别为683.24±211.83、557.39±128.29、545.82±129.76μm，均显著高于各组治疗1mo后随访时的CMT(412.09±257.38、356.29±133.02、322.78±109.55μm)，差异均有统计学意义(P<0.05)。雷珠单抗联合激光治疗的患者中出现结膜下出血6例6眼，眼压升高至25mmHg的患者2例2眼，均给予对症治疗后得以恢复。

结论：采用玻璃体内注射雷珠单抗联合577nm激光治疗视网膜阻塞合并黄斑水肿能够有效改善患者的视力，降低黄斑区视网膜厚度。

METHODS: Totally 64 patients(64 eyes)with retinal vein occlusion accompanied by macular edema were treated in our hospital from June 2014 to March 2017. Among them, 40 cases(40 eyes)were in the central retinal vein occlusion group, 24 cases(24 eyes)were in the branch retinal vein occlusion group. They were treated with intravitreal injection of ranibizumab 0.5mg, and the laser photocoagulation of 577nm was performed at 5 to 7d after injection. Meanwhile, 42 patients who did not wish to be treated with injection were treated with laser treatment only. The changes of the indexes before and after treatment were compared.

RESULTS: The average number of blocking group repeated injection of branch retinal vein for 1.71±0.79, while the average number of patients with repeated injection of central retinal vein occlusion was 2.11±0.80. All patients requiring repeated injections interval was greater than 30d. At 1mo after treatment, there was no patients with decreased visual acuity in branch retinal vein occlusion group, while there were 6 eyes with that in central retinal vein occlusion group, 14 eyes in simply laser group. The mean best corrected visual acuity(LogMAR)of the three groups was 0.87±0.60, 0.57±0.48 and 0.54±0.32, respectively, were significantly lower than that before treatment(1.26±0.53, 0.86±0.39, 0.76±0.26; P<0.05). The mean macular retinal thickness before treatment was 683.24±211.83, 557.39±128.29 and 545.82±129.76μm, were significantly higher than those at the last follow-up 412.09±257.38, 356.29±133.02 and 322.78±109.55μm(P<0.05). There were 6 cases of subconjunctival hemorrhage in patients treated with laser therapy combined with laser therapy. The intraocular pressure increased to 25mmHg in 2 eyes in 2 patients and recovered after symptomatic treatment.

CONCLUSION: Intravitreal injection of ranibizumab combined with 577nm laser treatment can greatly enhance the visual acuity, effective decrease macular retinal thickness in patients with retinal vein occlusion and macular edema.