雷珠单抗联合全视网膜光凝治疗缺血型视网膜中央静脉阻塞的疗效观察

目的　探讨雷珠单抗联合全视网膜光凝（panretinal photocoagulation，PRP）治疗缺血型视网膜中央静脉阻塞（central retinal vein occlusion，CRVO）的效果。方法　选取2014年6月至2016年6月我院收治的缺血型CRVO患者90例（90眼），采用随机数字表法分为观察组和对照组，每组各45例45眼，根据病程再将两组患者各分为两个亚组，A组病程≤3个月，B组病程>3个月，观察A、B组采用玻璃体内注射雷珠单抗（intravitreal injection of ranibizumab，IVR）+PRP治疗，对照A、B组采用单独PRP治疗，比较4组房水中血管内皮生长因子（vascular endothelial growth factor，VEGF）水平，记录IVR前、PRP时及PRP后1周、1个月、3个月最佳矫正视力（best corrected visual acuity，BCVA）、黄斑中心凹视网膜厚度（central macular thickness，CMT），并观察黄斑水肿复发率及不良反应。结果　观察A组和观察B组PRP时房水VEGF浓度较IVR前降低，且显著低于对照A组、对照B组，差异均有统计学意义（均为P＜0.05）；观察A组PRP时及PRP后1周、1个月、3个月BCVA均优于对照A组，观察B组优于对照B组（均为P＜0.05），且观察A组与观察B组、对照A组与对照B组比较，差异均有统计学意义（均为P＜0.05）；观察A组PRP后1周、1个月、3个月CMT均显著低于对照A组，观察B组低于对照B组（均为P＜0.05），但观察A组与观察B组、对照A组与对照B组各时间点比较，差异均无统计学意义（均为P＞0.05）；观察A组和对照A组均未出现黄斑水肿复发，观察B组、对照B组黄斑水肿复发率分别为6.25%、10.0%，4组比较差异无统计学意义（P＞0.05）；4组均未出现严重不良反应。结论　早期采用IVR联合PRP治疗缺血型CRVO效果确切，可显著改善视力水平。

Ranibizumab combined with panrentinal photocoagulation for the treatment of ischemic central retinal vein occlusion

Objective　To explore the effects of ranibizumab combined with panrentinal photocoagulation （PRP） in the treatment of ischemic central retinal vein occlusion （CRVO）.Methods　Totally 90 patients （90 eyes） with ischemic CRVO who were admitted to our hospital from June 2014 to June 2016 were enrolled in the study.They were divided into the observation group and the control group by random number table，45 patients （45 eyes） in each group.According to the course of the disease，patients in each group were divided into two subgroups，namely，the observation group A （the course ≤3 months） and B （the course >3 months）［all patients were treated by intravitreal injection of ranibizumab （IVR）+PRP］ and the control group A （the course ≤3 months） and B （the course >3 months)（all patients were treated by PRP alone）.The vascular endothelial growth factor （VEGF） in aqueous humor was compared among the 4 groups.The best corrected visual acuity （BCVA） and central macular thickness （CMT） were recorded before IVR，at PRP and at 1 week，1 month and 3 months after PRP.The recurrence rate of macular edema and adverse reactions during the follow-up period were statistically analyzed.Results　The VEGF levels in aqueous humor in the observation group A and B at PRP were significantly lower than those before injection of IVR and those in the control group A and B，with significant difference （all P<0.05）.The logMAR BCVA of the observation group A at PRP and at 1 week，1 month and 3 months after PRP was better than that of the control group A，and that of the observation group B groups was superior to that of the control group B，with significant differences between the observation group A and the observation group B or between the control group A and the control group B （all P<0.05）.The CMT of the observation group A at 1 week，1 month and 3 months after PRP was lower than that of the control group A，and that of the observation group B groups was smaller than that of the control group B，with significant difference （all P<0.05），but there was no significant difference between the observation group A and the observation group B or between the control group A and the control group B （both P>0.05）.No recurrence of macular edema was observed in the observation group A and the control group A.The recurrence rate of macular edema in the observation group B and the control group B were 6.25% and 10.0%，respectively，without significant difference among the 4 groups （P>0.05）.No serious adverse reactions were found in the 4 groups.Conclusion　Early application of IVR combined with PRP is effective in the treatment of ischemic CRVO，and the visual acuity can be improved significantly.