雷珠单抗联合532激光治疗视网膜静脉阻塞合并黄斑水肿
|
摘要
目的:对比玻璃体腔注射雷珠单抗联合小功率532激光治疗与单纯532激光治疗对视网膜静脉阻塞(RVO)继发黄斑水肿的疗效。方法:回顾性研究。选取我科2017-06/2018-03临床确诊的RVO继发黄斑水肿患者48例48眼,其中A组行玻璃体腔注射雷珠单抗联合小功率532激光治疗;B组单纯行532激光正常功率治疗。观察两组患者治疗前和治疗后1、2、3mo时的BCVA、CMT。结果:A组治疗前、治疗后1、2、3mo时BCVA为0.84±0.02、0.49±0.04、0.29±0.04、0.26±0.04;B组为0.85±0.04、0.58±0.01、0.53±0.01、0.53±0.02。A组治疗前、治疗后1、2、3mo时CMT分别为527.5±17.59、371±17.36、298.5±32.87、257.75±17.30μm;B组为535±16.36、425±24.44、420.25±17.70、427.75±17.89μm。两组患者治疗后组间比较,A组BCVA和CMT均小于B组(P<0.05)。通过不同时间点与治疗前的组内比较,可知CMT与BCVA数值缓慢下降,以A组治疗后3mo下降最为明显(P<0.05)。结论:两种方法治疗RVO合并黄斑水肿均有效,视力提高、ME减轻,病情得到有效控制。但联合小功率激光治疗与单纯行532激光组相比,联合组在减轻黄斑水肿、提高视力方面效果更佳。
·AIM: To compare the efficacy of intravitreal injection of ranibizumab plus low power 532 laser versus 532 laser alone for treating retinal vein occlusion(RVO) with macular edema complication.·METHODS: Retrospective study of 48 patients diagnosed RVO complicated with macular edema from June 2017 to March 2018. Group A of 31 eyes(31 patients) were treated with intravitreal injection of ranibizumab plus low power 532 laser(the power is about 2/3 of the power of group B, about 100-130 mw), and group B of 17 eyes(17 patients) were treated with 532 laser(the power is 150-200 mw) alone. The best corrected visual acuity(BCVA), foveal retinal thickness(CMT), FFA and fundus were observed both before and after treatment at timepoint of 1 mo, 2 mo and 3 mo between the two groups.·RESULTS: In group A, BCVA was 0.84±0.02, 0.49±0.04, 0.29±0.04, 0.26±0.04 before and the 1, 2, 3 mo after treatment. In group B, BCVA was 0.85±0.04, 0.58±0.01, 0.53±0.01, 0.53±0.02. The CMT value of group A before and after treatment was 527.5±17.59, 371±17.36, 298.5±32.87, 257.75±17.30μm, respectively. Group B was 535±16.36, 425±24.44, 420.25±17.70, 427.75±17.89μm. Intra-group comparison show statistical differences, group A had lower BCVA and CMT value than group B at the same time point(P<0.05). Inter-group comparison with pre-treatment, there was significant difference in BCVA between 1 mo, 2 mo and 3 mo after treatment(P<0.05). The CMT and BCVA value from group A are the lowest.·CONCLUSION: Both methods are effective in treating RVO with macular edema, improving vision, alleviating ME, and effectively controlling the disease.However, combined treatment can significantly reduce macular edema, improve vision, and be more stable than laser treatment alone.
·AIM: To compare the efficacy of intravitreal injection of ranibizumab plus low power 532 laser versus 532 laser alone for treating retinal vein occlusion(RVO) with macular edema complication.·METHODS: Retrospective study of 48 patients diagnosed RVO complicated with macular edema from June 2017 to March 2018. Group A of 31 eyes(31 patients) were treated with intravitreal injection of ranibizumab plus low power 532 laser(the power is about 2/3 of the power of group B, about 100-130 mw), and group B of 17 eyes(17 patients) were treated with 532 laser(the power is 150-200 mw) alone. The best corrected visual acuity(BCVA), foveal retinal thickness(CMT), FFA and fundus were observed both before and after treatment at timepoint of 1 mo, 2 mo and 3 mo between the two groups.·RESULTS: In group A, BCVA was 0.84±0.02, 0.49±0.04, 0.29±0.04, 0.26±0.04 before and the 1, 2, 3 mo after treatment. In group B, BCVA was 0.85±0.04, 0.58±0.01, 0.53±0.01, 0.53±0.02. The CMT value of group A before and after treatment was 527.5±17.59, 371±17.36, 298.5±32.87, 257.75±17.30μm, respectively. Group B was 535±16.36, 425±24.44, 420.25±17.70, 427.75±17.89μm. Intra-group comparison show statistical differences, group A had lower BCVA and CMT value than group B at the same time point(P<0.05). Inter-group comparison with pre-treatment, there was significant difference in BCVA between 1 mo, 2 mo and 3 mo after treatment(P<0.05). The CMT and BCVA value from group A are the lowest.·CONCLUSION: Both methods are effective in treating RVO with macular edema, improving vision, alleviating ME, and effectively controlling the disease.However, combined treatment can significantly reduce macular edema, improve vision, and be more stable than laser treatment alone.
引文
1秦书艳, 沈磊, 力强.玻璃体腔注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿.国际眼科杂志 2016;16(12):2329-2331
2刘慧峰, 贾俊, 姬明利, 等.康柏西普联合激光治疗视网膜静脉阻塞继发黄斑水肿.国际眼科杂志2017;17(11):2140-2143
3 Noma H, Mimura T, Eguchi S. Association of inflammatory factors with macular edema in branch retinal vein occlusion. JAMA Ophthalmol 2013;131(2):160-165
4葛坚.眼科学.北京:人民卫生出版社 2010:7
5 Klein R, Klei BE, Moss SE, et al. The epidemiology of retinal vein occlusion:the Beaver Dam Eye Study. Ophthalmol Soc 2000;98(2):133-143
6 McIntosh RL, Rogers SL, Lim L, et al. Natural history of cental retinal vein occlusion:an evidence-based systematic review. Ophthalmology 2010;117(6):1113-1123
7 Rogers SL, McIntosh RL. Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2010;117(6):1094-1101
8杨杰, 彭南祥, 陈季生.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.国际眼科杂志2017;17(10):1912-1914
9 Noma H, Funatsu H, Mimura T, et al. Vascular endothelial growth factor receptor-2 in macular oedema with retinal vein occlusion. Ophthalmic Res 2012;48(1):56-58
10 Chen CH, Chen YH, Wu PC, et al. Treatment of branch retinal vein occlusion induced macular edema in treatment-na?ve cases with a single intravitreal triamcinolone or bevacizumab injection. Chang Gung Med J 2010;33(4):424-435
11 Feng J, Zhang Y. Differences in aqueous concentrations of cytokines in macular edema secondary to branch and central retinal vein occlusion. PLoS One 2013;8(7):e68149
12 Gu X, Yu X, Dai H, et al. Intravitreal injection of ranibizumab for treatment of age-related macular degeneration: effects on serum VEGF concentration. Curr Eye Res 2014;39(5):518-521
13陈静, 赖铭莹, 罗恒,等.抗VEGF药物联合激光光凝治疗糖尿病性黄斑水肿观察研究.中国实用眼科杂志2014;32(6):693-697
14 Bandello F, Berchicci L, La Spina C, et al. Evidence for anti-VEGF treatment of diabetic macular edema. Ophthalmic Res 2012;48(Suppl 1N):16-20
15 Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion:six-month primary end point results of a phase III study. Ophthalmology 2010;117(6):1102-1112
16 Rouvas A, Petrou P, Ntouraki A, et al. Intravitreal ranibizumab(Lucentis) for branch retinal vein occlusion-induced macular edema:nine-month results of a prospective study. Retina 2010;30(6):893-902
17 Pece A, Isola V, Piermarocchi S, et al. Efficacy and safety of anti-vascular endothelial growth factor(VEGF) therapy with intravitreal ranibizumab(Lucentis) for na?ve retinal vein occlusion:1-year follow-up. Br J Ophthalmic 2011;95(1):56-68
18 Azad SV, Salman A, Mahajan D, et al. Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular edema secondary to branch retinal vein occlusion. Middle East Afr J Ophthalmic 2014;21(40):296-301
2刘慧峰, 贾俊, 姬明利, 等.康柏西普联合激光治疗视网膜静脉阻塞继发黄斑水肿.国际眼科杂志2017;17(11):2140-2143
3 Noma H, Mimura T, Eguchi S. Association of inflammatory factors with macular edema in branch retinal vein occlusion. JAMA Ophthalmol 2013;131(2):160-165
4葛坚.眼科学.北京:人民卫生出版社 2010:7
5 Klein R, Klei BE, Moss SE, et al. The epidemiology of retinal vein occlusion:the Beaver Dam Eye Study. Ophthalmol Soc 2000;98(2):133-143
6 McIntosh RL, Rogers SL, Lim L, et al. Natural history of cental retinal vein occlusion:an evidence-based systematic review. Ophthalmology 2010;117(6):1113-1123
7 Rogers SL, McIntosh RL. Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2010;117(6):1094-1101
8杨杰, 彭南祥, 陈季生.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.国际眼科杂志2017;17(10):1912-1914
9 Noma H, Funatsu H, Mimura T, et al. Vascular endothelial growth factor receptor-2 in macular oedema with retinal vein occlusion. Ophthalmic Res 2012;48(1):56-58
10 Chen CH, Chen YH, Wu PC, et al. Treatment of branch retinal vein occlusion induced macular edema in treatment-na?ve cases with a single intravitreal triamcinolone or bevacizumab injection. Chang Gung Med J 2010;33(4):424-435
11 Feng J, Zhang Y. Differences in aqueous concentrations of cytokines in macular edema secondary to branch and central retinal vein occlusion. PLoS One 2013;8(7):e68149
12 Gu X, Yu X, Dai H, et al. Intravitreal injection of ranibizumab for treatment of age-related macular degeneration: effects on serum VEGF concentration. Curr Eye Res 2014;39(5):518-521
13陈静, 赖铭莹, 罗恒,等.抗VEGF药物联合激光光凝治疗糖尿病性黄斑水肿观察研究.中国实用眼科杂志2014;32(6):693-697
14 Bandello F, Berchicci L, La Spina C, et al. Evidence for anti-VEGF treatment of diabetic macular edema. Ophthalmic Res 2012;48(Suppl 1N):16-20
15 Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion:six-month primary end point results of a phase III study. Ophthalmology 2010;117(6):1102-1112
16 Rouvas A, Petrou P, Ntouraki A, et al. Intravitreal ranibizumab(Lucentis) for branch retinal vein occlusion-induced macular edema:nine-month results of a prospective study. Retina 2010;30(6):893-902
17 Pece A, Isola V, Piermarocchi S, et al. Efficacy and safety of anti-vascular endothelial growth factor(VEGF) therapy with intravitreal ranibizumab(Lucentis) for na?ve retinal vein occlusion:1-year follow-up. Br J Ophthalmic 2011;95(1):56-68
18 Azad SV, Salman A, Mahajan D, et al. Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular edema secondary to branch retinal vein occlusion. Middle East Afr J Ophthalmic 2014;21(40):296-301