Early intravitreal bevacizumab for non‐ischaemic central retinal vein occlusion

Purpose: To evaluate the effect of early intravitreal bevacizumab injections for the treatment of macular oedema caused by non‐ischaemic central retinal vein occlusion (CRVO). Methods: The study included 25 patients (25 eyes) with macular oedema caused by non‐ischaemic central retinal vein occlusion, who received three intravitreal injections of 1.5 mg bevacizumab with an interval of 6 weeks between the injections. Mean duration of central retinal vein occlusion prior to the first injection was 4.2 ± 3.6 days. All patients were re‐examined 1, 3 and 6 months after the first injection. The main outcome parameters were visual acuity and macular thickness, as measured by optical coherence tomography. Results: Mean visual acuity improved significantly from 0.97 ± 0.40 logMAR at baseline to 0.70 ± 0.42 logMAR (P = 0.007) at 1 month, 0.69 ± 0.46 (P = 0.006) 3 months and 0.69 ± 0.52 (P = 0.015) 6 months after the first injection. Mean central retinal thickness decreased significantly from 530 ± 152 μm at baseline to 347 ± 127 μm (P < 0.001) at 1 month, 370 ± 165 μm (P < 0.001) 3 months and 346 ± 129 μm (P < 0.001) 6 months (P < 0.001) after the first injection. The increase in visual acuity correlated significantly (P < 0.01) with the decrease in macular thickness. Mean intraocular pressure was 14.2 ± 3.2 mmHg at baseline and did not differ significantly from the measurement obtained at 1 month (P = 0.59), 3 months (P = 0.88) and 6 months after the first injection (P = 0.65). Conclusion: Intravitreal bevacizumab injections given shortly after onset of non‐ischaemic central retinal vein occlusion may result in a significant increase in vision and a corresponding decrease in macular oedema.     

The effects of intravitreal bevacizumab on patients with macular edema secondary to branch retinal vein occlusion

Objective: To evaluate the effect of intravitreal bevacizumab on visual acuity (VA) and central retinal thickness (CRT) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Design: Retrospective review.Participants: The study included 42 patients with ME secondary to BRVO who received intravitreal injections of bevacizumab in 2 referral-based retinal practices in Vancouver, B.C., between November 2005 and July 2006.Methods: We performed a retrospective review of consecutive patients with ME secondary to BRVO. All of the patients in this study had nonischemic BRVOs. Patients were all treated with at least 1 bevacizumab injection and were seen at 6- to 8-week intervals for VA testing. Most of the patients also underwent optical coherence tomography (OCT) 2 months and 6 months after treatment. VA and OCT measurements at each follow-up time point were compared with the baseline values.Results: A total of 42 eyes from 42 patients with ME secondary to BRVO were reviewed. The mean VA improved from 20/280 at baseline to 20/180 at first follow-up session (p < 0.04; average follow-up = 42 days) and remained at a similar level, 20/170, through the eighth follow-up session (p < 0.04; average follow-up = 356). The CRT was reduced from a mean of 451 μm (388-512 μm) at baseline to 358 μm (298-418 μm) at 2 months (p < 0.02) and to 400 μm (335-465 μm) at 6 months postinjection (p < 0.068).Conclusions: We found a significant improvement in VA and CRT in patients with ME secondary to BRVO after intravitreal bevacizumab injection(s). No complications or serious side effects were observed. Intravitreal bevacizumab appears to have an emerging role as either a primary or an adjuvant treatment modality in the setting of ME secondary to BRVO.     

A prospective study on intravitreal bevacizumab (Avastin®) for neovascular age‐related macular degeneration of different durations

Purpose: Choroidal neovascularization (CNV) accounts for 85–90% of severe visual impairment in age‐related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is a major factor mediating angiogenesis, and VEGF inhibitors have become a new treatment modality. In this prospective study, we used bevacizumab (Avastin^®), a recombinant monoclonal antibody to VEGF, to treat neovascular AMD. Methods: The case material comprised 36 subjects (26 females, 10 males) aged 65–88 years with subfoveal neovascular AMD with all subtypes of CNV. There were two categories of patients: category I, long‐standing CNV (12 months or more), preoperative visual acuity (VA) 0.16 (mean); category II, CNV (duration <12 months), preoperative VA 0.25 (mean). Evaluation protocol included the Early Treatment Diabetic Retinopathy Study (ETDRS) VA, clinical ophthalmological examination, fluorescein angiography and optical coherence tomography (OCT). Intravitreal injections of bevacizumab (Avastin^®) (IVB), 1.25 mg (0.05 ml), were given under an operating microscope and aseptic conditions in a theatre for surgery with intervals of 4 or 6 weeks during the first 3 months and subsequently according to clinical assessment. The follow‐up was 6 months in all cases. Results: At 6 months, mean VA had improved by 4.6 ETDRS letters in the entire case material (P = 0.001), by 3.9 letters in category I (duration 12 months or more) and by 6.0 letters in category II (duration <12 months). A total of 148 IVB (mean 4.1 injections/eye) were delivered during 6 months, the first 3 months comprising 3.1 IVB (mean) and the last 3 months 1.0 IVB (mean). No eyes suffered visual decline of 15 ETDRS letters. Fluorescein angiograms displayed stabilization or regression of CNV activity; OCT showed resorption of intraretinal oedema and subretinal fluid. No severe complications occurred but recurrence was common, and repeated IVBs were necessary in most cases during the 6‐month period. Conclusion: When addressing the issue of frequency of IBV, we observed that 6‐week intervals were sufficient because VA and CNV lesions generally stabilized at 4 weeks. The gain in VA was promising in eyes with <12 months CNV duration. Even in eyes with a longer CNV duration, a slight visual improvement was observed when retinal oedema resorbed, although subretinal fibrosis and general cellular damage certainly limited recovery.     

Effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness and retinal vessel diameter in branch retinal vein occlusion

AIM: To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness (SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS: An interventional, restrospective study of 41 eyes of 41 patients who had completed 12mo of follow-up, divided into group 1 (1.25 mg of bevacizumab, 21 eyes of 21 patients) and group 2 (2.5 mg of bevacizumab, 20 eyes of 21 patients). Complete ophthalmic examination, fluorescein angiography, enhanced depth imaging optical coherence tomography and measurement of retinal vessel diameter with IVAN software were performed at baseline and follow-up. RESULTS: The SFChT changed from 279.1 (165-431) µm at baseline to 277.0 (149-413) µm at 12mo in group 1 (P=0.086), and from 301.4 (212-483) µm to 300.3 (199-514) µm in group 2 (P=0.076). The central retinal arteriolar equivalent (CRAE) changed from 128.8±11.2 μm at baseline to 134.5±8.4 μm at 12mo in group 1, and from 134.6±9.0 μm to 131.4±12.7 μm in group 2 (P=0.767). The central retinal venular equivalent (CRVE) changed from 204.1±24.4 μm at baseline to 196.3±28.2 μm at 12mo in group 1, and from 205.8±16.3 μm to 194.8±18.2 μm in group 2 (P=0.019). The mean central macular thickness (P<0.05) and average best-corrected visual acuity (BCVA; P<0.05) improved in both groups CONCLUSION: Changes in the SFChT are not statistically significant and not different according to the doses of bevacizumab. The CRAE did not show significant change, however, the CRVE showed significant decrease regardless of the dose.     

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best‐corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired‐t test. Side‐effects were monitored. Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow‐up, BCVA and CFT were significantly different compared to pre‐injection values in the same group (P = 0.032, 0.049 in the initial‐injection group and P = 0.001, 0.008 in the repeat‐injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time‐point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post‐injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.     

Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty‐three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4‐mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25‐mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best‐corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow‐up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.     

视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构改变与视力的相关性分析

目的　观察视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构的光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征,探讨黄斑区微结构的改变与视力的关系。方法　采用ＯＣＴ对４６例（４６眼）视网膜静脉阻塞合并黄斑水肿患者进行黄斑区微结构检查,分析黄斑水肿形态,对不同形态黄斑水肿的患者进行比较,以患眼作为黄斑水肿组,对侧眼作为对照组,分析黄斑区微结构各参数与视力的相关性。结果　ＯＣＴ扫描结果显示４６眼视网膜静脉阻塞合并黄斑水肿的患者黄斑区微结构表现为３种形态,１２眼为黄斑囊样水肿,１０眼为浆液性神经上皮层脱离,２４眼为混合型水肿即黄斑囊样水肿伴浆液性神经上皮层脱离。对照组黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积分别为（１８０．８１±１３．３５）μｍ、（２３８．７２±１６．７５）μｍ及（０．１７±０．０３）ｍｍ３,而黄斑水肿组分别为（５４１．２６±１２５．６８）μｍ、（４７３．６１±１３３．４２）μｍ及（０．３８±０．１４）ｍｍ３,两组比较差异均有统计学意义（均为Ｐ＝０．０００）。根据患者黄斑区微结构形态表现分组研究发现,浆液性神经上皮层脱离患者ＢＣＶＡ最好,为（０．５３±０．０９）ＬｏｇＭＡＲ,其次为黄斑囊样水肿患者（０．６４±０．１６）ＬｏｇＭＡＲ,而混合型患者最差（１．０２±０．２４）ＬｏｇＭＡＲ,３组之间差异有统计学意义（Ｐ＝０．００８）。浆液性神经上皮层脱离患者中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积最小,其次为黄斑囊样水肿患者,而混合型患者３个指标均最大,３组之间差异均有统计学意义（均为Ｐ＝０．０００）。对黄斑部微结构的改变与ＢＣＶＡ进行相关性分析发现:黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜容积、ＩＳ／ＯＳ断裂长度及外界膜断裂长度与ＢＣＶＡ（ＬｏｇＭＡＲ）均呈正相关（ｒ＝０．５４６,Ｐ＝０．０００;ｒ＝０．５８２,Ｐ＝０．０００;ｒ＝０．５２３,Ｐ＝０．０００;ｒ＝０．８３４,Ｐ＝０．０００;ｒ＝０．７５８,Ｐ＝０．０００）。黄斑水肿形态与ＢＣＶＡ呈正相关（ｒ＝０．６４１,Ｐ＝０．０００）,单纯的浆液性神经上皮层脱离患者ＢＣＶＡ最好,混合型的患者病变最重,ＢＣＶＡ也最差。结论　视网膜静脉阻塞所致的黄斑水肿表现形态不同,ＯＣＴ可以对黄斑部微结构改变进行定量分析,黄斑区形态改变与视力密切相关。     

Comparison of intravitreal ranibizumab and bevacizumab for the treatment of macular edema secondary to retinal vein occlusion

AIM:To compare the efficacy of ranibizumab and bevacizumab for macular edema due to retinal vein occlusion (RVO).METHODS:A retrospective study was conducted at a single academic institution. Eighty-one patients na?ve to anti-VEGF therapy with RVO and macular edema were identified. Twenty-six eyes were treated with ranibizumab, 33 eyes with bevacizumab, and 22 eyes with bevacizumab then switched to ranibizumab (crossover). The main outcome was change in visual acuity at 3 months, 6 months, and final visit.RESULTS:The mean visual acuity improved from 20/80 to 20/40 in the ranibizumab (R) group and from 20/125 to 20/60 in the bevacizumab (B) group (P=0.66). The mean change in central subfield thickness (CST) was -186 and -212μm, respectively (P=0.69). Mean time between injections was 94±21.1d in the R group and 103.8±10.5d in the B group (P=0.78). In the crossover group, mean initial visual acuity was 20/125, reached 20/60 at crossover, and remained 20/60 at conclusion (P=0.91).CONCLUSION:Both ranibizumab and bevacizumab are effective for the treatment of RVO and appear to have similar visual and anatomic outcomes. Changing treatments from bevacizumab to ranibizumab did not result in further gains in visual acuity.      

雷珠单抗治疗视网膜中央静脉阻塞并发黄斑水肿的报告

目的：：探讨玻璃体腔内注射雷珠单抗治疗视网膜中央静脉阻塞并发黄斑水肿的临床疗效。方法：选取2015-03/09我院收治的视网膜中央静脉阻塞并发黄斑水肿患者30例30眼行雷珠单抗玻璃体腔内注射,1次/mo,治疗1~3mo,治疗结束后随诊3mo,比较患者注射后最佳矫正视力、眼压、黄斑中心凹视网膜厚度、黄斑水肿消退率及眼底荧光血管造影检查结果。结果：随着雷珠单抗注射次数的增加,患者的最佳矫正视力逐渐提高(P<0.05),黄斑中心凹视网膜厚度明显下降(P<0.05),眼压与治疗前比较并无明显变化(P>0.05)。第1、2、3次注射后患者黄斑水肿消退率分别为47%、68%、94%。结论：玻璃体腔内注射雷珠单抗能够有效缓解视网膜中央静脉阻塞继发的黄斑水肿,明显改善患者的视力。     

Retinal sensitivity improvement after intravitreal triamcinolone acetonide injection for macular edema secondary to branch retinal vein occlusion

Purpose:

To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema(ME) secondary to branch retinal vein occlusion (BRVO).

Materials and Methods:

Total of 14 eyes of 14 cases of BRVO were included in this prospective study. In each eye, at baseline and 1, 3, and 6 months after IVTA injection, logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry, and optical coherence tomography foveal thickness were assessed.

Results:

Cases ages ranged from 60 to 79 years (mean 68 ± 8 years). At 1, 3, and 6 months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 μm to 254 ± 51 μm, 288 ± 84 μm, and 280 ± 91 μm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB, and 8.3 ± 4.6 dB, respectively.

Conclusion:

In eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity but also the central 4° retinal sensitivity in 6 months follow-up.     

Efficacy of combined intravitreal bevacizumab and triamcinolone for branch retinal vein occlusion

Purpose:

To evaluate the efficacy of combined treatment with intravitreal bevacizumab (IVB) and triamcinolone acetate (IVT) for patients with macular edema secondary to branch retinal vein occlusion (BRVO).

Materials and Methods:

Retrospective analysis of 20 eyes injected with 1.25 mg IVB and 2 mg IVT for clinically identified BRVO within 8 weeks of onset. All patients lacked concomitant ocular pathology and completed 6 months’ follow-up. Clinical examination including LogMAR visual acuity (VA) and central macular thickness (CMT) by spectralis optical coherence tomography (OCT) was performed preoperatively and at 1, 3 and 6 months post-operatively.

Results:

Mean patient age was 61.3 years with a mean BRVO diagnosis time of 3 weeks at presentation. VA improved from logMAR 1.08 preoperatively to Mean logMAR VA of 0.55 ± 0.17 at 1 month (P < 0.001), 0.56 ± 0.21 at 3 months (P < 0.001), and 0.38 ± 0.1 at 6 months (P < 0.001) Mean CMT improved from 482 ± 107 μm preoperatively to 319 ± 53 μm at 1 month (P < 0.001), 344 ± 89 μm at 3 months (P < 0.001), and 241 ± 29 μm at 6 months (P < 0.001). Mean IOP preoperatively was 16.5 mmHg, 21 mmHg at 1 month, and 15 mmHg at 6 months. Six out of 20 patients (30%) were re-injected with IVB and IVT at 3 months.

Conclusions:

Early combined treatment with IVB and IVT is effective in improving anatomic and functional outcomes in patients with macular edema secondary to BRVO.     

曲安奈德玻璃体腔重复注射治疗视网膜中央静脉阻塞性黄斑水肿的疗效评价

目的:研究玻璃体腔重复注射曲安奈德(intravitreal triam-cinolone,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)引起的黄斑水肿的临床效果。方法:研究对象为17例17眼接受IVTA(4mg)单次及重复注射的CRVO性黄斑水肿患者,均为人工晶状体眼或无晶状体眼(男/女=10/7),重复注射时间均为首次注射后16wk。在术前及术后1,2,3,4mo,分别测量单次注射组和重复注射组最佳矫正视力(best-corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)。采用配对-t检验对两组结果进行统计学分析。结果:单次注射组与重复注射组术前BCVA和CFT相比无显著差异。两次注射后BCVA及CFT均有短暂提高,虽然在随访结束时两组的BCVA及CFT与注射前仍有显著差异(单次注射组:P=0.032,0.049,重复注射组:P=0.01,0.008)。但重复注射组每个时间点BCVA均显著低于单次注射组(P值分别是0.043,0.011,0.010和0.012)。在注射后1,2,3mo,重复注射组CFT均显著高于单次注射组(P值分别是0.040,0.015和0.025)。单次及重复注射后眼压最高水平分别是20.0mmHg(SD2.06)和18.56mmHg(SD3.65),两者之间无显著性差异(P=0.467)。在随访期间未发现其它明显的副作用。结论:在治疗视网膜中央静脉阻塞引起的黄斑水肿时,4mgIVTA重复注射效果要差于单次注射。     

视网膜中央静脉阻塞的治疗现状

视网膜中央静脉阻塞是仅次于糖尿病性视网膜病变的常见视网膜血管病,常导致视力下降甚至失明,以往视网膜激光光凝术、手术、玻璃体腔注药等疗法对视网膜中央静脉阻塞的治疗有一定疗效,近年来一些新方法如抗新生血管内皮生长因子、地塞米松缓释剂以及联合治疗等的出现,取得较好效果,但更安全有效的治疗措施有待进一步研究.     

玻璃体内注射药物对视网膜静脉阻塞的治疗

视网膜静脉阻塞( retinal vein occlusion,RVO) 是继糖尿病性视网膜病变之后最常见的影响视网膜的视觉致残性疾病。虽然该疾病实体早已被认定,但其治疗仍存在争议。黄斑水肿是该视网膜血管性疾病中视力下降 ( visual acuity,VA) 的主要原因。最近玻璃体腔已越来越多地被用来作为一个药物储物,通过玻璃体腔注射直接治疗黄斑水肿。迄今最广泛的注射药物为曲安奈德( triamcinolone acetonide,TA) 和贝伐单抗。该论文的目的是评估证据,并讨论最近有人提出的关于玻璃体内注射皮质类固醇和抗血管内皮生长因子的药物治疗对视网膜静脉阻塞是有效的基本原理。     

Therapeutic potential of intravitreal pharmacotherapy in retinal vein occlusion

Retinal vein occlusion (RVO) is the most common visually disabling disease affecting the retina after diabetic retinopathy. Although the disease entity has long been known, its management is still controversial. Macular edema is the main reason for decreased visual acuity (VA) in this retinal vascular disorder. Recently the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of macular edema through intravitreal injection route. The most widely injected drugs so far have been triamcinolone acetonide (TA) and bevacizumab. The objective of this review is to evaluate the evidence and discuss the rationale behind the recent suggestions that intravitreal pharmacotherapy by corticosteroids and anti-vascular endothelial growth factors may be useful in the treatment of retinal vein occlusion.     

OCT在视网膜中央动脉阻塞中的应用及意义

目的：探讨光学相干断层扫描(optical coherence tomography,OCT)在视网膜中央动脉阻塞疾病中的应用及内层视网膜厚度与患者治疗前后视力是否存在相关性。

方法：回顾性分析视网膜中央动脉阻塞患者11例,收集患者发病至入院时间、初始视力、治疗后视力,行黄斑OCT测量黄斑区视网膜厚度,进行定量测定和分析黄斑中心凹、距中心小凹3mm及6mm上、下、鼻、颞侧扇形面积下视网膜全层的平均厚度。内层视网膜厚度采用人工手动测量。距黄斑中心小凹1mm处内层视网膜,鼻侧记为N1,颞侧记为T1,距黄斑中心小凹3mm处内层视网膜,鼻侧记为N3,颞侧记为T3。

结果：8/11的患者视力均有不同程度的提高; 患眼黄斑中心凹及鼻侧3mm扇形面积下视网膜全层厚度比健眼增厚(P<0.05),余各区域面积下视网膜全层厚度与健眼相比无统计学差异(P>0.05); 患眼N1、N3及T3均比健眼增厚(P<0.05); 黄斑中心凹厚度患眼与健眼的差值与治疗后视力呈负相关,r=-0.740(P<0.05); 患眼与健眼N1、T1、T3的差值与治疗后视力呈负相关,r_N1=-0.692,r_T1=-0.754,r_T3=-0.657(P<0.05)。

结论：OCT检查对视网膜中央动脉阻塞患者治疗后视力的恢复有提示作用。     

地塞米松玻璃体内植入剂联合抗VEGF药物治疗视网膜静脉阻塞

目的：比较地塞米松玻璃体内植入剂联合抗VEGF药物与抗VEGF药物单药治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)的疗效和安全性。

方法：选取2019-06/2020-12在厦门大学附属厦门眼科中心确诊为视网膜中央静脉阻塞(CRVO)或视网膜分支静脉阻塞(BRVO)继发黄斑水肿的患者133例133眼,其中CRVO-ME患者48眼,BRVO-ME患者85眼。将纳入患者随机分组,其中单药治疗组66眼接受每月注射康柏西普1次,连续3mo,之后每月复诊; 联合治疗组67眼接受地塞米松玻璃体内植入剂注射1次,1wk后注射康柏西普1次,之后每月复诊。随访6mo,观察两组患者最佳矫正视力(BCVA)和中央视网膜厚度(CRT)改善情况,记录康柏西普注射次数及与玻璃体腔注射治疗相关的眼部及全身不良事件发生情况。

结果：治疗后1、2、3、6mo,两组患者BCVA和CRT均较治疗前显著改善,但两组间BCVA和CRT改善程度均无差异(P>0.05)。首次玻璃体腔注射至治疗6mo时,单药治疗组和联合治疗组康柏西普玻璃体腔注射次数分别为3.56±0.12、2.96±0.17次,联合治疗组注射次数显著低于单药治疗组(P=0.004)。随访期间,联合治疗组高眼压和白内障发生率均高于单药治疗组。

结论：地塞米松玻璃体内植入剂联合抗VEGF药物是治疗RVO-ME的有效方法,可显著改善视力,降低CRT,该治疗方案可在减少抗VEGF药物注射次数的同时达到与抗VEGF药物单药治疗相似的疗效,但需要监控眼压变化及白内障进展情况。     

康柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞的疗效

目的:探讨康柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞的临床疗效。方法:选取2017-01/2019-01在我院诊治的缺血型视网膜中央静脉阻塞患者80例80眼进行回顾性研究。根据治疗方式分为两组,A组40例40眼采用玻璃体腔注射康柏西普3+PRN治疗联合全视网膜激光光凝治疗;B组40例40眼采用玻璃体腔注射康柏西普3+PRN治疗。分别记录治疗前及治疗后3、6、12mo患者的最佳矫正视力(BCVA)和黄斑中心凹视网膜厚度(CMT),观察药物注射次数及不良反应。结果:治疗后12mo与治疗前比较,A组BCVA由1.05±0.58改善至0.41±0.37(P<0.01),B组由0.98±0.51改善至0.63±0.53(P<0.01),两组间比较无差异(P>0.05);A组CMT由592.30±79.75μm下降至260.08±86.23μm(P<0.01),B组CMT由604.98±81.73μm下降至406.83±162.97μm(P<0.01),且两组间比较有差异(P<0.01)。A组康柏西普注射3.15±0.43次,B组3.83±1.06次,两组间比较有差异(P<0.01)。随访期间,A组患者均未出现不良反应,B组继发新生血管性青光眼2例2眼。结论:康柏西普治疗缺血型视网膜中央静脉阻塞安全有效,联合全视网膜激光光凝可以显著改善视力,黄斑水肿消退效果更佳更稳定,降低复发率,减少并发症。     

贝伐单抗治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿的短期疗效及影响因素分析

目的　观察玻璃体内注射贝伐单抗治疗视网膜中央静脉阻塞（central retinal vein occlusion,CRVO）继发黄斑水肿患者的临床特征及疗效,探讨对短期黄斑水肿恢复有影响的因素。方法　回顾性分析60例60眼CRVO继发黄斑水肿患者,采用玻璃体内注射贝伐单抗1.25 mg（0.05 mL）,必要时重复治疗,随访3个月观察患者最佳矫正视力（best-corrected visual acuity,BCVA）及黄斑中心视网膜厚度（central retinal thickness,CRT）改变。根据治疗后3个月时CRT恢复水平,分析患者的年龄、病程、基线视力、基线CRT、高血压及糖尿病、黄斑囊样水肿（cystoid macular edema,CME）或视网膜下液体（subretinal fluid,SRF）情况对黄斑水肿恢复的影响。结果　BCVA从基线（0.897±0.395）LogMAR提高到治疗后1个月的（0.616±0.350）LogMAR,并稳定持续至治疗后3个月（P＜0.001）,同时CRT从基线（721.2±180.8）μm降低到治疗后3个月的（392.1±185.4）μm（P＜0.001）。治疗后3个月56.7%的CME和超过90%的SRF均得到完全缓解。年龄和基线CRT低提示治疗后3个月时CRT恢复较好（P=0.036、0.037）。年龄大的患者（＞60岁）治疗后黄斑水肿消除更多（P=0.031）,治疗后3个月时CRT更低（P=0.003）。结论　玻璃体内注射贝伐单抗能有效提高BCVA并降低CRT。年龄大和基线CRT低提示治疗后3个月时CRT恢复较好。CRT的降低主要取决于CME是否消除,而与SRF无关。