单次玻璃体腔注射雷珠单抗联合激光治疗视网膜中央静脉阻塞继发黄斑水肿
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摘要
目的观察单次玻璃体腔注射雷珠单抗联合激光光凝治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿的临床疗效。方法回顾性病例对照研究。经荧光素眼底血管造影(FFA)确诊的CRVO继发黄斑水肿患者28例(28眼),根据是否联合雷珠单抗治疗分为联合治疗组和激光治疗组。比较治疗后1、6、12个月2组患者的最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)。应用重复测量方差分析及t检验进行统计学分析。结果 2组组间BCVA的总体差异无统计学意义(F=1. 16,P=0. 301)。2组不同随访时间BCVA的总体差异有统计学意义(F=2. 935,P=0. 039),其中联合治疗组治疗后1、6、12个月的BCVA较治疗前均有所提高,差异有统计学意义(t=3. 111、2. 677、2. 208,P=0. 009、0. 02、0. 047),而激光治疗组治疗后1、6、12个月的BCVA与治疗前比较差异无统计学意义。2组组间CMT的总体差异有统计学意义(F=4. 434,P=0. 045),其中联合治疗组治疗后1、6、12个月的CMT与同时间点激光治疗组相比,差异均有统计学意义(t=-2. 382、-3. 235、-2. 598,P=0. 025、0. 003、0. 015)。2组不同随访时间CMT的总体差异有统计学意义(F=113. 842,P <0. 01),2组治疗后1、6、12个月的CMT较治疗前均有所下降,差异有统计学意义(联合治疗组:t=5. 311、11. 574、11. 522,P <0. 01;激光治疗组:t=8. 037、8. 818、9. 322,P <0. 01)。结论单次玻璃体腔注射雷珠单抗联合视网膜激光光凝治疗可有效减轻CRVO继发黄斑水肿,提高患者的视力,其减轻黄斑水肿作用较单纯激光治疗更加明显。
Objective To assess the efficacy of single intravitreal injection of Ranibizumab combined with laser photocoagulation for the treatment of macular edema secondary to central retinal vein occlusion( CRVO).Methods In this retrospective study,28 patients( 28 eyes) with macular edema secondary to BRVO were diagnosed by using fundus fluorescein angiography( FFA). According to whether or not combined with Ranibizumab injection,all patients were divided into combination therapy group and laser therapy group. The best corrected visual acuity( BCVA)and central macular thickness( CMT) were compared between the two groups before treatment and 1,6,12 months after treatment. Statistical analysis was performed by repeated measures analysis of variance and t test. Results The difference of BCVA between the two groups was not statistically significant( F = 1. 16,P = 0. 301). The difference of BCVA at different time of follow-up between the two groups was statistically significant( F = 2. 935,P = 0. 039). The BCVA of combination therapy group at 1 month,6 months and 12 months after treatment were significantly increased compared with the BCVA before the treatment( t = 3. 111,2. 677,2. 208; P = 0. 009,0. 02,0. 047),while no significant difference was found in the laser therapy group. The difference of CMT between the two groups was statistically significant( F = 4. 434,P = 0. 045). The CMT of combination therapy group at 1 month,6 months and 12 months after treatment were significantly lower than the laser group at the same time( t =-2. 382,-3. 235,-2. 598;P = 0. 025,0. 003,0. 015). The difference of BCVA at different time of follow-up between the two groups was statistically significant( F = 113. 842,P < 0. 01). The CMT of the two groups at 1 month,6 months and 12 months after treatment were significantly decreased compared with the CMT before the treatment( combination therapy group: t =5. 311,11. 574,11. 522,P < 0. 01; laser therapy group: t = 8. 037,8. 818,9. 322,P < 0. 01). Conclusions Single intravitreal injection of Ranibizumab combined with laser photocoagulation can relieve macular edema secondary to CRVO and improve the visual acuity. It is more effective on the relief of macular edema than laser treatment alone.
Objective To assess the efficacy of single intravitreal injection of Ranibizumab combined with laser photocoagulation for the treatment of macular edema secondary to central retinal vein occlusion( CRVO).Methods In this retrospective study,28 patients( 28 eyes) with macular edema secondary to BRVO were diagnosed by using fundus fluorescein angiography( FFA). According to whether or not combined with Ranibizumab injection,all patients were divided into combination therapy group and laser therapy group. The best corrected visual acuity( BCVA)and central macular thickness( CMT) were compared between the two groups before treatment and 1,6,12 months after treatment. Statistical analysis was performed by repeated measures analysis of variance and t test. Results The difference of BCVA between the two groups was not statistically significant( F = 1. 16,P = 0. 301). The difference of BCVA at different time of follow-up between the two groups was statistically significant( F = 2. 935,P = 0. 039). The BCVA of combination therapy group at 1 month,6 months and 12 months after treatment were significantly increased compared with the BCVA before the treatment( t = 3. 111,2. 677,2. 208; P = 0. 009,0. 02,0. 047),while no significant difference was found in the laser therapy group. The difference of CMT between the two groups was statistically significant( F = 4. 434,P = 0. 045). The CMT of combination therapy group at 1 month,6 months and 12 months after treatment were significantly lower than the laser group at the same time( t =-2. 382,-3. 235,-2. 598;P = 0. 025,0. 003,0. 015). The difference of BCVA at different time of follow-up between the two groups was statistically significant( F = 113. 842,P < 0. 01). The CMT of the two groups at 1 month,6 months and 12 months after treatment were significantly decreased compared with the CMT before the treatment( combination therapy group: t =5. 311,11. 574,11. 522,P < 0. 01; laser therapy group: t = 8. 037,8. 818,9. 322,P < 0. 01). Conclusions Single intravitreal injection of Ranibizumab combined with laser photocoagulation can relieve macular edema secondary to CRVO and improve the visual acuity. It is more effective on the relief of macular edema than laser treatment alone.
引文
[1]IP M,HENDRICK A.Retinal vein occlusion review[J].Asia Pac JOphthalmol,2018,7(1):40-45.
[2]刘卫.视网膜静脉阻塞继发黄斑水肿的治疗进展[J].中国眼耳鼻喉科杂志,2015,15(4):236-239.
[3]Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion:the Central Vein Occlusion Study Group[J].Opahthalmology,1995,102(10):1425-1433.
[4]陆秉文,吴星伟.视网膜静脉阻塞激发黄斑水肿的治疗进展[J].中华眼底病杂志,2013,29(6):640-644.
[5]王文吉.视网膜静脉阻塞[J].中国眼耳鼻喉科杂志,2012,12(2):78-81.
[6]NOMA H,FUNAUSU H,MIMURA T,et al.Vitreous level of interleukin-6 and vascular endothelial growth factor in macular edema with central retinal vein occlusion[J].Ophthalmology,2009,116(1):87-93.
[7]林莉,陈松.玻璃体腔内注射抗血管内皮生长因子单克隆抗体ranibizumab治疗视网膜静脉阻塞黄斑水肿的研究现状[J].中华眼底病杂志,2013,29(6):637-640.
[8]吴李鑫,张悦,刘海芸.玻璃体腔注射雷珠单抗联合激光治疗视网膜中央静脉阻塞继发黄斑水肿[J].中国实用眼科杂志,2015,33(9):1004-1007.
[9]BRYNSKOV T,KEMP H,SRENSEN T L.Intravitreal ranibizumab for retinal vein occlusion through 1 year in clinical practice[J].Retina,2014,34(8):1637-1643.
[10]STEFNSSON E.The therapeutic effects of retinal laser treatment and vitrectomy.A theory based on oxygen and vascular physiology[J].Acta Ophthalmol Scand,2001,79(5):435-440.
[11]BROWN D M,CAMPOCHIARO P A,SINGH R P,et al.Ranibizumab for macular edema following central retinal vein occlusion:six-month primary end point results of a phaseⅢstudy[J].Ophthalmology,2010,117(6):1124-1133.
[12]CAMPOCHIARO P A,BROWN DM,AWH C C,et al.Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion:12-month outcomes of a phaseⅢstudy[J].Ophthalmology,2011,118(10):2041-2049.
[13]ZHANG Y,YAO Z,KAILA N,et al,Pharmacokinetics of ranibizumab after intravitreal administration in patients with retinal vein occlusion or diabetic macular edema[J].Ophthalmology,2014,121(11):2237-2246.
[14]HEIER J S,CAMPOCHIARO P A,YAU L,et al.Ranibizumab for macular edema due to retinal vein occlusions:long-term follow-up in the HORIZON trial[J].Ophthalmology,2012,119(4):802-809.
[15]CAMPOCHIARO P A,SOPHIE R,PEARLMAN J,et al.Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab:the RETAIN study[J].Ophthalmology,2014,121(1):209-219.
[2]刘卫.视网膜静脉阻塞继发黄斑水肿的治疗进展[J].中国眼耳鼻喉科杂志,2015,15(4):236-239.
[3]Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion:the Central Vein Occlusion Study Group[J].Opahthalmology,1995,102(10):1425-1433.
[4]陆秉文,吴星伟.视网膜静脉阻塞激发黄斑水肿的治疗进展[J].中华眼底病杂志,2013,29(6):640-644.
[5]王文吉.视网膜静脉阻塞[J].中国眼耳鼻喉科杂志,2012,12(2):78-81.
[6]NOMA H,FUNAUSU H,MIMURA T,et al.Vitreous level of interleukin-6 and vascular endothelial growth factor in macular edema with central retinal vein occlusion[J].Ophthalmology,2009,116(1):87-93.
[7]林莉,陈松.玻璃体腔内注射抗血管内皮生长因子单克隆抗体ranibizumab治疗视网膜静脉阻塞黄斑水肿的研究现状[J].中华眼底病杂志,2013,29(6):637-640.
[8]吴李鑫,张悦,刘海芸.玻璃体腔注射雷珠单抗联合激光治疗视网膜中央静脉阻塞继发黄斑水肿[J].中国实用眼科杂志,2015,33(9):1004-1007.
[9]BRYNSKOV T,KEMP H,SRENSEN T L.Intravitreal ranibizumab for retinal vein occlusion through 1 year in clinical practice[J].Retina,2014,34(8):1637-1643.
[10]STEFNSSON E.The therapeutic effects of retinal laser treatment and vitrectomy.A theory based on oxygen and vascular physiology[J].Acta Ophthalmol Scand,2001,79(5):435-440.
[11]BROWN D M,CAMPOCHIARO P A,SINGH R P,et al.Ranibizumab for macular edema following central retinal vein occlusion:six-month primary end point results of a phaseⅢstudy[J].Ophthalmology,2010,117(6):1124-1133.
[12]CAMPOCHIARO P A,BROWN DM,AWH C C,et al.Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion:12-month outcomes of a phaseⅢstudy[J].Ophthalmology,2011,118(10):2041-2049.
[13]ZHANG Y,YAO Z,KAILA N,et al,Pharmacokinetics of ranibizumab after intravitreal administration in patients with retinal vein occlusion or diabetic macular edema[J].Ophthalmology,2014,121(11):2237-2246.
[14]HEIER J S,CAMPOCHIARO P A,YAU L,et al.Ranibizumab for macular edema due to retinal vein occlusions:long-term follow-up in the HORIZON trial[J].Ophthalmology,2012,119(4):802-809.
[15]CAMPOCHIARO P A,SOPHIE R,PEARLMAN J,et al.Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab:the RETAIN study[J].Ophthalmology,2014,121(1):209-219.