雷珠单抗联合激光光凝术治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿疗效观察

目的探讨雷珠单抗联合激光光凝术治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿疗效。方法选取我院2015年1月至2016年12月收治BRVO继发黄斑水肿患者共90例,随机分为A组(30例)、B组(30例)及C组(30例),分别采用雷珠单抗单纯玻璃体内注射、单纯激光光凝术及雷珠单抗玻璃体内注射+激光光凝术治疗;比较3组患者治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(central macular thickness,CMT)、眼压及并发症发生率。结果 A组治疗后3个月、6个月及12个月BCVA分别为0.80±0.12、0.72±0.08、0.67±0.06;B组治疗后3个月、6个月及12个月BCVA分别为0.63±0.09、0.60±0.06、0.47±0.04;C组治疗后3个月、6个月及12个月BCVA分别为0.59±0.06、0.54±0.05、0.43±0.04;B、C组患者治疗后3个月、6个月及12个月BCVA均显著低于A组(F=2.51、2.68、2.91,P=0.03、0.02、0.02)。A组治疗后3个月、6个月及12个月CMT分别为(359.15±77.95)μm、(365.27±53.38)μm、(300.25±39.01)μm;B组治疗后3个月、6个月及12个月CMT分别为(304.32±59.20)μm、(327.68±40.91)μm、(246.23±30.04)μm;C组治疗后3个月、6个月及12个月CMT分别为(209.30±54.39)μm、(264.33±37.80)μm、(208.17±29.34)μm;B、C组治疗后3个月、6个月及12个月CMT均显著小于A组(F=3.78、4.66、5.14,均为P=0.00)。3组患者治疗后3个月眼压比较差异无统计学意义(F=0.95,P=0.64);C组患者治疗后6个月和12个月眼压均显著低于A、B组(F=2.45、2.60,P=0.03、0.02)。3组患者术后并发症发生率差异无统计学意义(χ~2=2.14,P=0.38)。结论相较于单纯应用激光光凝术和雷珠单抗玻璃体内注射术,雷珠单抗玻璃体内注射+激光光凝术治疗BRVO继发黄斑水肿可有效改善视力,降低CMT,且未加重并发症发生风险。

Ranibizumab combined with laser photocoagulation in the treatment of patients with macular edema secondary to branch retinal vein occlusion

Objective　To investigate the efficacy of laser photocoagulation and ranibizumab for the treatment of patients with macular edema secondary to branch retinal vein occlusion （BRVO）.Methods　Totally 90 patients with macular edema secondary to BRVO were chosen in the period from January 2015 to December 2016 in our hospital and randomly divided into 3 groups including A group （30 patients） undergoing ranibizumab administration alone and B group （30 patients） receiving laser photocoagulation alone and C group （30 patients） receiving both ranibizumab administration with laser photocoagulation；and the levels of the best corrected visual acuity （BCVA） and central macular thickness （CMT） and eye pressure before and after treatment and the complications incidence of the three groups were compared.Results　The levels of BCVA of A group in 3 months，6 months and 12 months after treatment were 0.80±0.12，0.72±0.08，0.67±0.06，respectively；the levels of BCVA of B group in 3 months，6 months and 12 months after treatment were 0.63±0.09，0.60±0.06，0.47±0.04，respectively；the levels of BCVA of C group in 3 months，6 months and 12 months after treatment were 0.59±0.06，0.54±0.05，0.43±0.04，respectively.The levels of BCVA of B group and C group in 3 months，6 months and 12 months after treatment were significant better than A group（F=2.51，2.68，2.91，P=0.03，0.02，0.02）.The levels of CMT of A group，B group and C group in 3 months，6 months and 12 months after treatment were（359.15±77.95）μm，（365.27±53.38）μm，（300.25±39.01）μm；（304.32±59.20）μm，（327.68±40.91）μm，（246.23±30.04）μm and（209.30±54.39）μm，（264.33±37.80）μm，（208.17±29.34）μm.The levels of CMT of B group and C group in 3 months，6 months and 12 months after treatment were significant better than those of A group（F=3.78，4.66，5.14，all P=0.00，0.00，0.00）.There was no significant difference in the eye pressure in 3 months after treatment among the 3 groups（F=0.95，P=0.64）.The eye pressure of B group and C group in 6 and 12 months after treatment were significant better than that of A group（F=2.45，2.60，P=0.03，0.02）.There was no significant difference in the complications incidence among the 3 groups （χ²=2.14，P=0.38）.Conclusion　Compared with laser photocoagulation and ranibizumab administration alone，the combination methods for the treatment of patients with macular edema secondary to BRVO can achieve efficiently higher visual acuity，reduce the levels of CMT.