地塞米松玻璃体内植入剂联合抗VEGF药物治疗视网膜静脉阻塞

目的：比较地塞米松玻璃体内植入剂联合抗VEGF药物与抗VEGF药物单药治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)的疗效和安全性。

方法：选取2019-06/2020-12在厦门大学附属厦门眼科中心确诊为视网膜中央静脉阻塞(CRVO)或视网膜分支静脉阻塞(BRVO)继发黄斑水肿的患者133例133眼，其中CRVO-ME患者48眼，BRVO-ME患者85眼。将纳入患者随机分组，其中单药治疗组66眼接受每月注射康柏西普1次，连续3mo，之后每月复诊； 联合治疗组67眼接受地塞米松玻璃体内植入剂注射1次，1wk后注射康柏西普1次，之后每月复诊。随访6mo，观察两组患者最佳矫正视力(BCVA)和中央视网膜厚度(CRT)改善情况，记录康柏西普注射次数及与玻璃体腔注射治疗相关的眼部及全身不良事件发生情况。

结果：治疗后1、2、3、6mo，两组患者BCVA和CRT均较治疗前显著改善，但两组间BCVA和CRT改善程度均无差异(P>0.05)。首次玻璃体腔注射至治疗6mo时，单药治疗组和联合治疗组康柏西普玻璃体腔注射次数分别为3.56±0.12、2.96±0.17次，联合治疗组注射次数显著低于单药治疗组(P=0.004)。随访期间，联合治疗组高眼压和白内障发生率均高于单药治疗组。

结论：地塞米松玻璃体内植入剂联合抗VEGF药物是治疗RVO-ME的有效方法，可显著改善视力，降低CRT，该治疗方案可在减少抗VEGF药物注射次数的同时达到与抗VEGF药物单药治疗相似的疗效，但需要监控眼压变化及白内障进展情况。

Efficacy of Dexamethasone intravitreal implant combined with anti-VEGF drug in the treatment of retinal vein occlusion

AIM: To compare the efficacy and safety of dexamethasone intravitreal implant combined with anti-VEGF drug and anti-VEGF drug monotherapy in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).

METHODS: A total of 133 patients(133 eyes)diagnosed with central retinal vein occlusion(CRVO)or branch vein occlusion(BRVO)secondary to macular edema in the Xiamen Eye Center of Xiamen University from June 2019 to December 2020, including 48 patients with CRVO-ME and 85 patients with BRVO-ME were analyzed. All patients were randomly assigned to monotherapy or combination therapy. The monotherapy group(66 eyes)received a monthly injection of conbercept for consecutive 3mo, followed by monthly follow-up visits; The combination therapy group(67 eyes)received once intravitreal dexamethasone implantation, and conbercept was injected once 1wk later, followed by monthly follow-up visits.All patients in the two treatment groups were evaluated at baseline and every subsequent visit until 6mo after treatment with the best corrected visual acuity(BCVA), macular central retinal thickness(CRT), and injection times of conbercept and ocular and systemic adverse events associated with intravitreal injection therapy were recorded.

RESULTS: At 1, 2, 3 and 6mo after treatment, the BCVA and CRT in both groups were significantly improved than before.But there was no significant difference in the improvement of BCVA and CRT(P >0.05). From the initial intravitreal injection to 6mo, the injection times of the monotherapy group and the combination therapy group were 3.56±0.12 and 2.96±0.17 times, respectively. The injection times of the combination therapy group were significantly lower than those of the monotherapy group(P=0.004). Both the incidences of intraocular hypertension and cataract in the combination therapy group were higher than those in the anti-VEGF monotherapy group.

CONCLUSION: dexamethasone intravitreal implant combined with anti-VEGF drugs is an effective method for the treatment of RVO-ME, with significantly improved visual acuity and significantly lower CRT; The combined treatment regimen can reduce the times of injections and achieve similar results to anti-VEGF drug monotherapy. However, monitoring of intraocular pressure and cataract progression is required.