雷珠单抗对视网膜分支静脉阻塞继发黄斑水肿患者视网膜血流密度的影响

目的　探讨雷珠单抗对视网膜分支静脉阻塞（BRVO）继发黄斑水肿患者视网膜深层和浅层血流密度的影响。方法　选取2019年7月至2020年7月洛阳市第三人民医院眼科收治的BRVO继发黄斑水肿患者62例（62眼）作为病例组，同期以年龄、性别等为匹配条件选取健康者36人（36眼）作为对照组。采用OCTA扫描模式对两组受试者黄斑区视网膜浅层毛细血管丛（SVC）血流密度、深层毛细血管丛（DVC）血流密度、黄斑中心凹无血管区域（FAZ）面积、FAZ周长、非圆度指数（AI）及FAZ范围300 μm宽度内的血流密度（FD-300）等参数进行测量。病例组患者接受玻璃体内注射雷珠单抗治疗，连续治疗3个月（每月注射1次），治疗后随访6个月，观察治疗后1个月、3个月、6个月病例组患者各项视网膜血流参数及最佳矫正视力（BCVA）。采用Pearson相关性分析法分析病例组患者治疗后的BCVA与各项视网膜血流参数的相关性。结果　治疗前病例组患者SVC血流密度、旁中心凹SVC血流密度、DVC血流密度、旁中心凹DVC血流密度、FD-300均小于对照组，差异均有统计学意义（均为P<0.05）；治疗前病例组患者黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度、FAZ面积、FAZ周长、AI均大于对照组，差异均有统计学意义（均为P<0.05）。与治疗前相比，病例组患者治疗后1个月、3个月、6个月的黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度均降低，差异均有统计学意义（均为P<0.05）；与治疗前相比，病例组患者治疗后3个月、6个月的FAZ面积均增加，差异均有统计学意义（均为P<0.05）；与治疗后1个月相比，病例组患者治疗后6个月的FAZ面积增加，差异有统计学意义（P<0.05）；与治疗前相比，病例组患者治疗后1个月、3个月、6个月的AI均降低，差异均有统计学意义（均为P<0.05）；病例组患者BCVA随治疗时间的延长逐渐改善，不同时间点两两比较，差异均有统计学意义（均为P<0.05）。治疗后6个月病例组患者BCVA与黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度、AI均呈正相关性（r=0.341、0.339、0.308，P=0.013、0.015、0.042），BCVA与FAZ面积呈负相关性（r=-0.337，P=0.017）。结论　BRVO继发黄斑水肿患者视网膜血流密度等参数存在异常，经雷珠单抗治疗后部分参数得到改善。

Effect of ranibizumab on the density of retinal blood flow in patients with macular edema secondary to branch retinal vein occlusion

Objective　To investigate the effect of ranibizumab on the changes of the density of deep and superficial retinal blood flow in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods　Sixty-two patients (62 eyes) with ME secondary to BRVO admitted to the Ophthalmology Department of Luoyang Third People’s Hospital from July 2019 to July 2020 were selected as the case group, and 36 normal subjects (36 eyes) matched with age and gender were selected as the control group during the same period. Flow density of superficial vascular complex (SVC) in the macular retina, flow density of deep vascular complex (DVC), the area and perimeter of foveal avascular zone (FAZ), asymmetry index (AI) and vessel density within a 300 μm wide region of the FAZ (FD-300) were measured using the scanning mode of OCT angiography (OCTA). Patients in the case group received intravitreal ranibizumab injection for 3 months (1 injection per month) and were followed up for 6 months after treatment. SVD, DVD, FAZ, AI, FD-300 and the best corrected visual acuity (BCVA) were observed at 1 month, 3 months and 6 months after treatment. Pearson’s correlation analysis was performed to analyze the correlation between BCVA and SVD, DVD, FAZ, AI, and FD-300 in the case group after 6 months of treatment.Results　Flow density of SVC in the macular retina and parafovea, flow density of DVC in the macular retina and parafovea and FD-300 in the case group before treatment were significantly lower than those of control group (all P<0.05). Flow density of SVC and DVC in the fovea centralis, the area and perimeter of FAZ and AI in the case group before treatment were significantly higher than those of control group (all P<0.05). Compared with pretreatment levels, flow density of SVC and DVC in the fovea centralis was significantly reduced at 1 month, 3 months and 6 months after treatment in the case group (all P<0.05). FAZ area at 3 months and 6 months after treatment in the case group was significantly enlarged compared with pretreatment levels (both P<0.05). FAZ area at 6 months after treatment was significantly larger than that at 1 month after treatment in the case group (P<0.05). In the case group, AI at 1 month, 3 months and 6 months after treatment was significantly reduced than those of pretreatment levels (all P<0.05). Patients in the case group had a gradually decreased BCVA (logMAR) with the prolongation of treatment, which was statistically significant in the comparison of that measured in the two time points (P<0.05). Pearson’s correlation test showed that BCVA at 6 months after treatment in the case group was positively correlated with flow density of SVC in the fovea (r=0.341, P=0.013), flow density of DVC in the fovea (r=0.339, P=0.015) and AI (r=0.308, P=0.042). BCVA was negatively correlated with FAZ area (r=-0.337, P=0.017).Conclusion　Patients with ME secondary to BRVO have abnormal retinal blood flow density and other parameters, some of which can be improved by ranibizumab mediation.