两种方法治疗视网膜分支静脉阻塞继发黄斑水肿的疗效观察

目的对比观察玻璃体腔注射抗VEGF药物(康柏西普眼用注射液)与视网膜激光光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)的疗效。方法回顾2015年10月至2018年10月在中国人民解放军第九八九医院就诊的BRVO继发ME患者62例(62眼),注药组患者知情选择行玻璃体腔注射抗VEGF药物,注药方案按照1+PRN进行,共38例(38眼);激光组患者均知情选择行视网膜激光光凝治疗,共24例(24眼);视病情均行黄斑区格栅光凝或局灶光凝治疗。患者于注药术或激光治疗后1个月、3个月、6个月复诊,随诊时观察患者的最佳矫正视力(BCVA)、眼压、眼底、光学相干断层扫描测量的黄斑中心凹厚度(CMT)变化,并随诊并发症情况。结果注药组随访结束时BCVA优于激光组(P<0.05);且注药组在随访1个月、3个月时BCVA均优于激光光凝组(P<0.05)。注药组和激光组治疗后1个月、3个月、6个月时CMT均较术前减小(P<0.05)。两组治疗后1个月、3个月、6个月时眼压比较差异无统计学意义(P>0.05)。随访期间所有患者均未发生与药物、玻璃体内注射相关的全身不良反应。结论玻璃体腔注射抗VEGF药物治疗BRVO继发ME可改善视力,减轻黄斑水肿,且效果优于视网膜激光光凝。

Clinical observation of two methods for macular edema secondary to branch retinal vein occlusion

【Objective】To compare the therapeutic effects of intravitreal injection of anti-VEGF drug(Conbercept)and laser photocoagulation on branch retinal vein occlusion(BRVO)with macular edema.【Methods】Sixty-two patients(62 eyes)with macular edema secondary to BRVO who made informed treatment choices and were treated in No.989 Hospital of People's Liberation Army Joint Logistic Support Force from October 2015 to October 2018 were retrospectively analyzed.Patients in drug injection group were given intravitreal injection of anti-VEGF drug(Conbercept),and the injection was performed according to 1+PRN in 38 cases(38 eyes);patients in laser photocoagulation group were given laser photocoagulation therapy(24 eyes).All patients were treated with grid photocoagulation or focal photocoagulation in macular area.The changes of macular fovea thickness(CMT)measured by optical coherence tomography(OCT),best corrected visual acuity(BCVA),intraocular pressure(IOP),and fundus oculi were observed at 1 month,3 months and 6 months after treatment.The complications were followed up.【Results】At 1-month,3-month follow-up,and at the end of follow-up,BCVA in the injection group was superior to that in the laser group,and the difference was statistically significant(P<0.05).The macular fovea thickness of drug injection group and laser photocoagulation group decreased 1 month,3 months and 6 months after treatment compared with that before treatment,and the difference was statistically significant(P<0.05).One month,3 months and 6 months after treatment,the difference in IOP between the two groups was not statistically significant(P>0.05).During the follow-up period,there were no complications such as infection and intraocular hemorrhage in the vitreous cavity.【Conclusion】Intravitreal injection of anti-VEGF drug in the treatment of macular edema secondary to BRVO can improve vision,reduce macular edema,and the effect is better than laser photocoagulation.