CAJ | 학술논문

目的观察玻璃体腔注射抗血管内皮生长因子(VEGF)单克隆抗体Ranibizumab联合眼底激光光凝对视网膜静脉阻塞(RVO)继发黄斑水肿短期临床疗效及安全性.方法前瞻性无对照研究.对2012年8月至2013年5月在天津市眼科医院就诊的RVO继发黄斑水肿患者32例(32只眼)分为视网膜分支静脉阻塞为(BRVO)组12例(12只眼)、视网膜中央静阻塞为(CRVO)组20例(20只眼)纳入研究.给予所有患者玻璃体腔注射Ranibizumab (IVR) 0.5 mg治疗.注射后5～7 d行577 nm黄激光光凝治疗,必要时对患眼进行玻璃体腔重复注射.治疗前后均行最佳矫正视力(BC-VA)、眼压、荧光素眼底血管造影(FFA)及相干光断层扫描(OCT)检查.矫正视力检查采用国际标准视力表,进行logMAR对数转换分析.对比IVR治疗前后BCVA、黄斑中心凹视网膜厚度(CRT)的变化,并对重复注射次数、治疗前后BCVA与治疗前CRT进行直线回归分析.结果随访3～10个月,平均随访5.07个月.BRVO组患者IVR 1～3次,平均(1.69±0.85)次;治疗前后BCVA和CRT差异均有统计学意义(t =3.832、4.496,P＜0.05).CRVO组患者IVR 1～4次,平均(2.14±0.79)次,治疗前后BCVA和CRT差异均有统计学意义(t=3.884、5.797,P＜0.05).两种RVO,治疗前后BC-VA差异有统计学意义(r=0.854、0.673,P＜0.05),而IVR注射次数与治疗前BCVA、CRT,治疗前后BCVA与治疗前CRT均无相关性(P＜0.05).所有患者随访期间均未发生与药物、玻璃体腔注射有关的眼部和全身不良反应.结论 IVR联合眼底激光光凝的应用可降低RVO继发黄斑水肿患者黄斑区视网膜厚度,提高患者的视力,必要时进行玻璃体腔重复注射,长期疗效待进一步观察.
목적 관찰파리체강주사항혈관내피생장인자(VEGF)단극륭항체Ranibizumab연합안저격광광응대시망막정맥조새(RVO)계발황반수종단기림상료효급안전성.방법 전첨성무대조연구.대2012년8월지2013년5월재천진시안과의원취진적RVO계발황반수종환자32례(32지안)분위시망막분지정맥조새위(BRVO)조12례(12지안)、시망막중앙정조새위(CRVO)조20례(20지안)납입연구.급여소유환자파리체강주사Ranibizumab (IVR) 0.5 mg치료.주사후5～7 d행577 nm황격광광응치료,필요시대환안진행파리체강중복주사.치료전후균행최가교정시력(BC-VA)、안압、형광소안저혈관조영(FFA)급상간광단층소묘(OCT)검사.교정시력검사채용국제표준시력표,진행logMAR대수전환분석.대비IVR치료전후BCVA、황반중심요시망막후도(CRT)적변화,병대중복주사차수、치료전후BCVA여치료전CRT진행직선회귀분석.결과 수방3～10개월,평균수방5.07개월.BRVO조환자IVR 1～3차,평균(1.69±0.85)차;치료전후BCVA화CRT차이균유통계학의의(t =3.832、4.496,P＜0.05).CRVO조환자IVR 1～4차,평균(2.14±0.79)차,치료전후BCVA화CRT차이균유통계학의의(t=3.884、5.797,P＜0.05).량충RVO,치료전후BC-VA차이유통계학의의(r=0.854、0.673,P＜0.05),이IVR주사차수여치료전BCVA、CRT,치료전후BCVA여치료전CRT균무상관성(P＜0.05).소유환자수방기간균미발생여약물、파리체강주사유관적안부화전신불량반응.결론 IVR연합안저격광광응적응용가강저RVO계발황반수종환자황반구시망막후도,제고환자적시력,필요시진행파리체강중복주사,장기료효대진일보관찰.
Objective To observe a short-term effectiveness of combination intravitreal injections of ranibizumab and retinal laser photocoagulation for macular edema secondary to RVO.Methods A prospective,open-controlled study observed 32 eyes of 32 patients with macular edema secondary to RVO,including 12 branch retinal vein occlusion (BRVO) eyes,20 central retinal vein occlusion (CRVO) eyes.All the patients were examined for BCVA of standard visual acuity chart logarithmic transforming to logMAR for statistical analysis,intraocular pressure,FFA and OCT before and after treatment.The eyes received 0.5mg intravitreal Lucentis,combining 577nm retinal laser photocoagulation within 5 to 7 days.Repeated injections were received in necessary.The BCVA,macular central retinal thickness (CRT) and ocular and systemic adverse reactions about drugs and treatments were followed up.Spearman correlation coefficient was used to measure the strength of correlation between repeated injection times,BCVA and CRT.Results The follow-up ranged from 3 to 10 months,an average of 5.07 months.No ocular or systemic adverse events were observed in follow-up period.The repeat time of injections in BRVO eyes was 1 to 3 months,and mean times (1.69±0.85).The difference of mean BCVA and CRT before and after therapy was statistically meaningful (t =3.832,4.496,P ＜0.05).The repeated times of injection in CRVO eyes was 1 to 4,and mean times (2.14±0.79),the difference of mean BCVA and CRT before and after therapy was statistically meaningful (t =3.884,5.797,P ＜0.05).BCVA post-treatment was correlated to BCVA pre-treatment (r =0.854,0.673,P ＜0.05) in any RVO.The repeated times had no correlation with baseline BCVA and CRT (P□0.05).BCVA pre-treatment and post-treatment had no correlation with baseline CRT (P0.05).Conclusions In the treatment of RVO with ME,combining intravitreal injection of Lucentis and retinal laser photocoagulation can reduce the degree of CRT,improve the visual function.Repeated injections are needed in necessary.The long term effectiveness is expected to look further.