康柏西普与雷珠单抗治疗非缺血型视网膜分支静脉阻塞继发黄斑水肿的对比观察

目的对比观察康柏西普与雷珠单抗治疗非缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿随访12个月的疗效及注射次数。方法回顾性非随机对照临床研究。收集2016年1月～2017年1月在我院确诊为非缺血型BRVO继发黄斑水肿的患者共38例(38眼),按照治疗药物分为2组,即康柏西普治疗组22例,雷珠单抗组16例,2组均采用按需要治疗(1+PRN)的给药方式。2组患者首次治疗后每月随访1次,共12个月,每次随访检查最佳矫正视力(BCVA)、眼压、检眼镜(眼底镜)、眼底照相、黄斑光学相干层析成像(OCT)。若病情需要则补充荧光素眼底血管造影(FFA)检查。通过观察2组患者BCVA、平均黄斑中心凹厚度(CMT)的变化以及12个月内的总注射次数,比较2种药物的长期疗效。结果随访12个月,2组在治疗后各随访期的BCVA、CMT均比治疗前明显好转(P值均<0. 05); 2组间治疗前和治疗后各随访期的BCVA、CMT水平基本相同,差异无统计学意义(P> 0. 05)。随访12个月,康柏西普组平均注射次数为(1. 64±0. 70)次,雷珠单抗组平均注射次数为(1. 88±0. 67)次,2组之间差异有统计学意义(P <0. 05)。结论康柏西普与雷珠单抗1+PRN方案治疗非缺血型BRVO继发黄斑水肿,观察12个月疗效均确实可靠;康柏西普能有效减少注射次数。     

雷珠单抗临床应用新进展概述

雷珠单抗(ranibizumab)是第二代人源化抗血管内皮生长因子(VEGF)重组鼠单克隆抗体片段,能与所有活性形式的VEGF-A结合,防止其与VEGFR1及VEGFR2结合,从而减少血管内皮细胞增殖和降低血管通透性,抑制新生血管生成。近年来,其临床应用范围不断扩大,新的观察结果和观点、理念不断涌现。现将近年来雷珠单抗在眼科临床应用的最新进展作一综述。     

Factors affecting visual acuity after one year of follow up after repeated intravitreal ranibizumab for macular degeneration

Aim

Providing intravitreal ranibizumab therapy for neovascular age related macular degeneration (nARMD) is a source of increasing strain for many UK eye departments. Whilst most units attempt to adhere to the product licence of following up patients at four weekly intervals; delays in follow up appointments can and do occur. We aim to see if mean follow up intervals during the maintenance phase are correlated with visual outcomes at one year and perform a multivariate analysis of patient factors in a bit to understand the factors affecting visual acuity outcomes.

Method

A continuously updated prospective audit of patients receiving ranibizumab therapy at the Royal Gwent Hospital was accessed and a coefficient of determination and Spearman’s rank test undertaken to see whether mean follow up delays resulted in visual acuity penalties after nine months of maintenance. Multivariate analysis using ANOVA was then undertaken to examine in more detail the various factors affecting visual acuity outcomes.

Results

805 eyes of 708 patients were included in the study. Mean follow up intervals varied between 28.0 and 96.3 days over the first six treatments of the maintenance phase (mean 49.2 – SD 10.7) with a mean change in visual acuity from baseline of +7.1 letters at 12 weeks and +4.6 letters at 52 weeks. There was a negative correlation seen between visual acuity gains after nine months of the maintenance phase and increasing clinic follow up times although Spearman’s rank analysis demonstrated a correlation coefficient of only −0.078, which was not statistically significant. Variability in follow up appointments resulting in worse outcomes was however significant (p < 0.01), as was increasing age at presentation (p = 0.04). Smoking was found to decrease age of presentation by six years (74.2 years vs 80.0 years). The adjusted R² for the whole analysis was 0.44.

Conclusion

Wide variation in follow up intervals was associated with a worse visual acuity outcome although longer mean follow up interval was not. Smokers presented at a significantly younger age than non-smokers or ex-smokers. This was a large study with an adjusted R² of 0.44. The results are relevant to other macular degeneration service providers around the world.     

Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration

PurposeTo investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD).MethodsA retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection.ResultsOne month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 µm and 121.68 µm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up.ConclusionsVA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.     

雷珠单抗玻璃体腔注射联合小梁切除术+视网膜光凝术治疗新生血管性青光眼的疗效研究

目的 探讨雷珠单抗玻璃体腔注射联合小梁切除术(NPTS)+视网膜光凝术(PRP)治疗新生血管性青光眼(NVG)的疗效,为临床治疗提供指导。方法 选择我院2013年1月～2018年1月接诊的60例NVG患者进行研究。按照治疗方法的不同将患者分为对照组和观察组。对照组接受NPTS+PRP治疗,观察组接受雷珠单抗玻璃体腔注射联合NPTS+PRP治疗。比较两组治疗效果,术前、术后1、3、6个月的眼压情况及术后并发症。结果 观察组的治疗总有效率(96.67%)明显高于对照组(80.00%),差异有统计学意义(P0.05)。术前两组眼压相比差异无统计学意义(P0.05);术后1、3、6个月,观察组眼压均明显低于对照组,差异有统计学意义(P0.05)。观察组并发症总发生率(6.67%)明显低于对照组(30.00%),差异有统计学意义(P0.05)。结论 雷珠单抗玻璃体腔注射联合NPTS+PRP治疗NVG的疗效显著,能够明显改善患者的眼压情况,降低并发症发生率,值得临床上应用及推广。     

抗VEGF治疗在眼科的临床意义及研究进展

目前许多抗血管内皮生长因子(VEGF)药物被用于治疗各种眼科疾病,尤其在血管增生性眼病的治疗中扮演着重要角色,这些药物能够明显抑制新生血管且减轻水肿提高患者视力,但其长期治疗效果需要更长远的随访和研究。本文就抗VEGF在眼科的应用及研究进展进行综述,为临床应用和深入研究提供参考。     

新型EX-PRESS青光眼引流器联合雷珠单抗治疗新生血管性青光眼

目的:观察新型EX-PRESS青光眼引流器植入术联合雷珠单抗治疗新生血管性青光眼(NVG)的临床疗效及安全性。方法:选择2015-06/2018-06在我院确诊为NVG且行玻璃体腔注射雷珠单抗的患者78例78眼,将其中随访资料完整者60例60眼根据治疗方式不同分为试验组30例30眼,行EX-PRESS青光眼引流器植入术。对照组30例30眼行常规小梁切除术。观察术后1wk,1、3、6mo及1a BCVA、眼压,术后早期并发症,于术后6mo,1a评估手术成功率。结果:术后1wk,1、3mo,试验组BCVA<0.1者25眼、25眼和23眼,平均眼压为16.76±3.21、15.63±2.70及16.69±3.29mmHg,对照组为26眼、26眼和25眼,平均眼压为17.31±2.96、14.44±2.53及16.56±4.14mmHg(均P>0.05);术后6mo,1a试验组BCVA<0.1者为16眼和16眼,平均眼压为15.49±3.19、18.52±4.03mmHg,对照组为25眼和25眼,平均眼压分别为21.96±2.90、28.90±4.33mmHg(均P<0.05);试验组术后低眼压、浅前房、前房出血、炎症反应、脉络膜脱离的发生例数分别为0眼、1眼、2眼、1眼、0眼,而对照组分别为6眼、6眼、5眼、4眼、2眼;试验组术后6mo,1a手术成功率为83%及80%,而对照组分别为60%及53%(P<0.05)。结论:EX-PRESS青光眼引流器植入术联合玻璃体腔注射雷珠单抗治疗NVG能够有效地降低患者的眼压,且具有手术切口小、操作简单、安全、术后并发症少、手术成功率高等优点。     

抗VEGF药物玻璃体腔内注射联合23 G玻璃体切除术对增殖性糖尿病视网膜病变患者的疗效分析

目的分析抗血管内皮生长因子(VEGF)药物玻璃体腔内注射联合23 G玻璃体切除术对增殖性糖尿病视网膜病变(PDR)患者的疗效。方法选取2017年1月~2019年1月河南省人民医院88例PDR患者(88只眼),根据治疗方案分组,各44例(44只眼)。对照组给予23 G玻璃体切除术,实验组给予抗VEGF药物玻璃体腔内注射+23 G玻璃体切除术。观察2组手术时间、电凝止血使用率,对比术前术后最佳矫正视力。结果实验组电凝止血使用频率较对照组低,手术时间较对照组短(P<0.05);与对照组比较,术后实验组最佳矫正视力较高(P<0.05);实验组并发症发生率为4.54%,低于对照组18.18%(P<0.05)。结论PDR患者采取抗VEGF药物玻璃体腔内注射和23 G玻璃体切除术联合治疗,可减少并发症,缩短手术时间,提高视力。     

雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿

目的：观察雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿(DME)的临床疗效。

方法：选取2016-06/2019-09就诊于广西壮族自治区人民医院确诊为重度DME的患者52例52眼,随机分为观察组(26例26眼,予雷珠单抗联合577nm微脉冲激光治疗)和对照组(26例26眼,仅予雷珠单抗治疗)。两组患者均予“3+PRN”方案行玻璃体腔注射雷珠单抗治疗。治疗(首次玻璃体腔注射)后随访9mo,观察黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)情况及玻璃体腔注射雷珠单抗次数。

结果：与治疗前相比,两组患者治疗后各时间点CMT、BCVA均明显改善(均P<0.001),但两组间均无差异(P>0.05)。随访期间,观察组玻璃体腔雷珠单抗注射次数明显少于对照组(5.88±1.24次 vs 7.12±1.24次,P=0.001)。

结论：雷珠单抗联合577nm微脉冲激光和单用雷珠单抗均能有效降低重度DME患者黄斑水肿程度,改善视力,但联合治疗可减少雷珠单抗的注射次数。