雷珠单抗单次玻璃体腔注射对糖尿病黄斑水肿的治疗作用

目的：观察玻璃体腔单次注射雷珠单抗(intravitreal injection ranibizumab，IVR)对糖尿病黄斑水肿的短期治疗作用。

方法：回顾性研究行玻璃体腔注射雷珠单抗治疗的有临床意义的糖尿病黄斑水肿患者29例29眼，术前均未行其他任何眼部治疗。所有患眼均行单次雷珠单抗(0.05mL，10mg/mL)玻璃体腔注射。分别记录注射前及注射后4、8、16wk所有患眼的最佳矫正视力(best corrected visual acuity，BCVA)、黄斑中心凹视网膜厚度(central foveal thickness，CFT)及光感受器内外节交界(IS/OS)完整性。根据光学相干断层扫描(optical coherence tomography，OCT)检查光感受器带内外节交界完整性与否分为光感受器完整及光感受器缺损组，分别比较两组术前、术后BCVA及CFT，并分析光感受器内外节交界完整性与BCVA的相关性。

结果：IVR后4、8wk，患者BCVA明显提高，较术前有统计学差异(P=0.009、0.003)，黄斑水肿缓解，CFT明显降低，差异较术前有统计学意义(P<0.01、P=0.001)。16wk后IVR药物作用降低，BCVA较4、8wk明显下降(P=0.043、0.019)，CFT值增加，黄斑水肿复发(P<0.01、P=0.005)。IVR后4wk和8wk比较，BCVA和CFT均无明显统计学差异(P=0.074、0.420)。OCT光感受器内外节交界完整组术前和术后4wk比较，BCVA无明显变化，差异无明显统计学意义(P=0.076)，而CFT较术前明显降低(P=0.001)，黄斑水肿减轻。OCT光感受器内外节交界缺损组术后4wk时BCVA较术前明显提高(P<0.01)，黄斑水肿减轻(P<0.01)。治疗前及治疗后4wk患者的视力情况与光感受器内外节交界完整性存在明显的相关性(P=0.015、0.024)。

结论：一次IVR后短期内视力及黄斑水肿程度均有改善，中心凹部光感受器内外节交界完整性与视力密切相关，IVR消除黄斑水肿的同时，也可能对中心凹部光感受器内外节交界损伤具有修复作用。

Efficacy of single intravitreal injection of Ranibizumab for diabetic macular edema

AIM: To observe the efficacy of single time intravitreal injection of ranibizumab(IVR)in patients with diabetic macular edema(DME).

METHODS: Twenty-nine cases of DME patients who complied with diagnostic criteria for clinically significant macular edema were enrolled in this retrospective study. All the patients receive single dose IVR(0.05mL, 10mg/mL), and no other eye treatments were performed before this operation. All data were recorded before and after injection of 4, 8, and 16wk. Best corrected visual acuity(BCVA), central foveal thickness(CFT), the integrity of the foveal photoreceptor layer on optical coherence tomography were analyzed. The data of photoreceptor integrity and photoreceptor defect group also were recorded and analyzed.

RESULTS: BCVA was significantly improved at 4 and 8wk after IVR(P=0.009,0.003), macular edema was relieved, and CFT was significantly lower in the same time(P<0.01,P=0.001). But the drug action was weakened in 16wk, BCVA was poorer than that in 4 and 8wk(P=0.043,0.019), macular edema recurred CFT increased(P<0.01,P=0.005). BCVA and CFT value were not statistically significant different between 4 and 8wk(P=0.074,0.420). There was no significant change in BCVA before and after surgery in photoreceptor complete group(P=0.076), but CFT was lower obviously(P=0.001). BCVA and CFT value were better in photoreceptor defect group after IVR in 4wk(P<0.01,P<0.01). There was significant correlation between visual acuity and photoreceptor integrity before and after treatment in 4wk(P=0.015, 0.024).

CONCLUSION: Patients with DME treated with ranibizumab obtained great improvements in vision and macular edema in the short term. Macular photoreceptor integrity was closely related to the vision. IVR may also repair the macular photoreceptor damage.