卵磷脂络和碘胶囊辅助治疗视网膜静脉阻塞的临床疗效研究

目的 探究卵磷脂络合碘胶囊联合雷珠单抗对视网膜静脉阻塞继发黄斑水肿(RVO-ME)的临床疗效。 方法 选取2020年1月至2021年2月就诊的40例40眼RVO-ME患者为研究对象,随机分为两组,雷珠单抗组和卵磷脂联合组,雷珠单抗组19例,卵磷脂联合组 21例,雷珠单抗组每4周给予玻璃体腔内注射雷珠单抗治疗,卵磷脂联合组是在雷珠单抗组治疗的基础上加用卵磷脂络合碘胶囊治疗,治疗 12 周,治疗期间每4周随访一次,观察治疗前后眼压、最佳矫正视力(BCVA)、眼底出血面积、黄斑中心区厚度(CMT)、 中心凹无血管区(FAZ)、 脉络膜血流面积(CFA)、浅层视网膜毛细血管层(SCP)和深层视网膜毛细血管层(DCP)的血管密度变化,并观察有无不良事件和不良反应的发生。 结果 两组患者各治疗时间点BCVA(LogMAR)、CMT均较治疗前改善,组间比较均无统计学差异。FAZ、SCP两组患者治疗前后无统计学差异,且组间比较无统计学差异。两组患者各治疗时间点眼底出血面积均较治疗前减少,卵磷脂联合组各治疗时间点的眼底出血吸收情况均优于雷珠单抗组,差异具有统计学意义。两组患者治疗前后CFA有增加趋势,差异具有统计学意义,组间比较无统计学差异。随访12周,两组患眼DCP呈明显增加趋势,差异具有统计学意义,且卵磷脂联合组DCP改善情况优于雷珠单抗组,差异具有统计学意义。 结论 卵磷脂络合碘胶囊辅助治疗视网膜静脉阻塞能更好地促进眼底出血的吸收、增加深层视网膜毛细血管密度,无明显不良反应。     

雷珠单抗玻璃体内注射治疗早产儿视网膜病变

〔摘 要〕 目的：探讨雷珠单抗玻璃体内注射治疗对早产儿视网膜病变（ROP）患儿视网膜功能发育的影响。 方法：选取 2019 年 2 月至 2021 年 2 月南昌大学第二附属医院收治的 ROP 患儿 106 例（共 212 眼），按照计算机分组法将其分为激光 组（激光手术方案，53 例，106 眼）和雷珠组（璃体内注射雷珠单抗方案，53 例，106 眼）。观察两组患儿临床疗效、视 网膜功能发育情况。 结果：雷珠组患儿治疗总有效率为 92.45 %，高于激光组的 77.36 %，差异具有统计学意义（P ＜ 0.05）。 治疗后，雷珠组患儿视锥细胞 b 波振幅、视杆细胞 b 波振幅均高于激光组，血管内皮生长因子 A 水平低于激光组，差异均 具有统计学意义（P ＜ 0.05）。术后，两组患者不良事件发生率比较差异无统计学意义（P ＞ 0.05）。 结论：相比激光手术， 玻璃体内注射雷珠单抗治疗 ROP 能提高临床疗效，更易促进患儿视网膜功能发育，且安全性较高。     

Advantage of combined procedure in vitreous surgery

Lens preservation facilitates the progression of nuclear cataracts after vitreous surgery among patients over 45 years old, and postoperative nuclear cataracts frequently necessitate intraocular lens surgery. Once the lens is removed, the fundus from the posterior pole to the ciliary process becomes recognizable and surgically reachable, thus making total vitreous removal possible. The complete removal of the incarcerated vitreous to the scleral wound prevents postoperative vitreous base tears, and anterior hyaloidal fibrovascular proliferation. Simultaneous vitreous surgery plus intraocular lens surgery (triple surgery) will prevent these complications before they arise. Triple surgery for patients over 45 years of age is reasonable even if they have amplitude of accommodation, and is an effective surgical strategy in that it improves both the result of the vitreous surgery and the patient’s quality of life.     

Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy: A case report

BACKGROUNDWaldenström macroglobulinemia (WM) is a distinct clinicopathologic entity characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M (IgM) in the blood, and patients may present with symptoms related to the infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood. Funduscopic abnormalities were noted in some of the patients due to hyperviscosity or other retinal lesions. Optical coherence tomography angiography (OCTA) as a non-invasive imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels, which might be useful for diagnosing patients with WM-associated retinopathy.CASE SUMMARYThe patient was a 67-year-old man who presented with sudden visual disturbance in both eyes. Ophthalmic tests showed that best corrected visual acuity (BCVA) for this patient was 20/100 in the right eye and 20/1000 in the left eye. Fundus examination, optical coherence tomography (OCT), and OCTA revealed substantial bilateral optic disc edema, dilated and tortuous retinal veins, and diffuse intraretinal blot hemorrhages and edema which were consistent with bilateral central retinal vein occlusion (CRVO). Meanwhile, remarkable bilateral serous macular detachments (SMD) were noticed on OCT. Systemic examinations showed that the patient had anemia and extremely high level of monoclonal IgM and infiltration of clonal lymphoplasmacytic cells in bone marrow. The diagnosis of WM with hyperviscosity and retinopathy was made based on the clinical manifestation and laboratory findings. He was subsequently treated with intravitreal ranibizumab injection, plasmapheresis, and bortezomib plus rituximab with dexamethasone. Six months after treatments, the central macular volume decreased by 16.1% in the right eye and 28.6% in the left eye on OCT, and the patient’s BCVA was improved to 20/60 in the right eye and 20/400 in the left eye. Very good partial response was obtained after systemic treatment.CONCLUSIONWM may affect visual function and present as bilateral CRVO. OCTA can show characteristic changes in both retina and choroid vasculatures, which might be of great value for diagnosing or following patients with WM retinopathy. Intravitreal anti-vascular endothelial growth factor treatment combined with systemic therapy might be beneficial for WM patients with retinopathy (SMD and CRVO).     

Comparison of Ranibizumab monotherapy versus combination of Ranibizumab with photodynamic therapy with neovascular age‐related macular degeneration

Purpose: Modern therapy of neovascular age‐related macular degeneration consists in intravitreal injections of inhibitors of the vascular endothelial growth factor. An increasing number of these injections is required not only in monthly but also in as‐needed treatment regimen. In this study, it should be examined whether an additional administered photodynamic therapy (PDT) can considerably reduce the number of injection. Methods: In this prospective, randomized study carried out in three large hospitals of Vienna eyes with neovascular age‐related macula degeneration were included. Patients were randomized to either Ranibizumab monotherapy or combined standard fluence PDT and Ranibizumab therapy. All patients received a loading dose of three intravitreal Ranibizumab injections and were thereafter treated in an as‐needed regimen based on distance acuity and retinal thickness values. In the combined treatment group, PDT was administered 1 day after the first Ranibizumab injection. Results: Fifty‐one patients were randomized, 44 were finally included (four screening failures and three withdrawals). Twenty‐four patients were assigned to the monotherapy and 20 patients to the combined treatment group. Fewer injections were required in the combined treatment group (4.7 versus 6.3). Overall the patients lost 0.5 letters; in the combined treatment group, the patients lost mean 7.1 letters; in the monotherapy group, they gained mean 5.1 letters. Retinal thickness decreased significantly in both groups. Conclusion: A significant reduction of the number of required intravitreal injections could be achieved by the additional PDT treatment, but was accompanied by a worse functional outcome in this group.     

光动力疗法联合玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管

目的评价光动力疗法(photodynamic therapy,PDT)联合玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管(idiopathic choroidal neovascularization,简称特发性CNV)的临床疗效。方法临床确诊为活动期特发性CNV患者30例30眼,随机分为PDT治疗组(PDT组)及PDT联合玻璃体腔注射雷珠单抗治疗组(联合组)。对比分析治疗前及治疗后1,3mo患者最佳矫正视力(best corrected visual acuity,BCVA)及黄斑中心厚度(central macular thickness,CMT)变化。结果治疗后1mo,3 mo分别与治疗前相比:PDT组及联合组BCVA平均值均提高,CMT平均值均降低,差异具有统计学意义(P0.05);两组间比较BCVA变化及CMT变化差异具有统计学意义(P0.05)。治疗后3mo与1mo相比:PDT组与联合治疗组BCVA平均值、CMT平均值差异均无统计学意义(P0.05)。结论 PDT治疗与PDT联合玻璃体腔注射雷珠单抗治疗均可减少CNV引起的视力下降;联合治疗的效果及稳定性要优于单纯的PDT治疗。     

地塞米松玻璃体内植入与雷珠单抗治疗视网膜静脉阻塞的疗效比较

目的：比较地塞米松玻璃体内植入与玻璃体注射雷珠单抗治疗视网膜静脉阻塞(RVO)的疗效。

方法：回顾性研究。选取本院40例ROV患者,根据治疗方式不同分为2组,A组采用地塞米松玻璃体内植入进行治疗,B组采用玻璃体腔注射雷珠单抗,比较两组患者治疗前后眼压、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、浅层血管复合体(SVC)层、深层血管复合体(DVC)层、脉络膜层与脉络膜毛细血管层黄斑区血流密度(MVD)、黄斑中心凹无血管区(FAZ)面积,记录复发及不良反应情况。

结果：两组患者治疗12mo BCVA、CMT均较治疗前得到明显改善(P<0.05),但两组间比较无显著差异(P>0.05); 治疗后,两组间SVC层、脉络膜层、脉络膜毛细血管层MVD比较均无显著差异(P>0.05),A组DVC层MVD显著大于B组(P<0.05); 两组患者治疗前后浅层与深层FAZ面积比较均无显著差异(P>0.05); 两组患者治疗后结膜下出血、异物感发生率比较均无显著差异(P>0.05),A组高眼压发生率明显高于B组(P<0.05); 两组患者黄斑水肿(ME)复发率比较无显著差异(P>0.05),但A组平均复发时间明显长于B组(P<0.05)。

结论：相较于玻璃体腔注射雷珠单抗,地塞米松玻璃体内植入可更好增加DVC层MVD,疗效维持时间更长,但应注意高眼压不良反应风险。     

玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性疗效比较

目的：探讨玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性(ARMD)疗效,并分析对患者最佳矫正视力(BCVA)、中心凹视网膜厚度(CRT)和并发症的影响。

方法：回顾性分析。收集2017-01/2020-01我院收治的渗出型ARMD患者60例60眼临床资料,按治疗药物不同分为玻璃体腔注射雷珠单抗组30眼和玻璃体腔注射康柏西普组30眼。比较两组患者治疗前,治疗1、2、3mo时患者BCVA、CRT、脉络膜新生血管变化和并发症发生情况。

结果：治疗后1、2、3mo,两组患者BCVA(LogMAR)较治疗前显著改善(P<0.05),CRT较治疗前显著降低(P<0.05),且玻璃体腔注射康柏西普组治疗1、2、3mo的CRT显著低于玻璃体腔注射雷珠单抗组(P<0.05); 两组脉络膜新生血管恢复情况和并发症发生情况比较无明显差异(P>0.05)。

结论：玻璃体腔注射雷珠单抗和康柏西普治疗渗出型ARMD均可取得较好的疗效,二者在改善视力方面无明显差异,但康柏西普治疗渗出型ARMD在降低CRT方面更具有明显优势。