继发黄斑水肿的视网膜中央静脉阻塞患眼脉络膜厚度的变化及雷珠单抗治疗效果的临床研究

目的探讨继发黄斑水肿的视网膜中央静脉阻塞(CRVO)患者脉络膜厚度的变化及雷珠单抗的治疗效果。 方法收集2019年11月至2021年10月在首都医科大学附属北京同仁医院眼科中心接受玻璃体腔注射雷珠单抗治疗CRVO继发黄斑水肿的患者54例(54只眼)。其中，男性30例(30只眼)，女24例(24只眼)；年龄25~71岁，平均年龄(55.27±12.03)岁。全部患眼均采用玻璃体腔内注射雷珠单抗治疗，治疗方案为前3个月，每个月注射一次，3个月后根据患者的病情按需注射。全部患者均随访6个月。检测并记录患眼治疗前后的黄斑中心凹视网膜厚度(CFT)；检测并记录患眼及对侧眼治疗前后的黄斑中心凹下脉络膜厚度(SFCT)。CFT和SFCT的检查结果经检验符合正态分布，以±s表示。患眼治疗前后CFT的比较、患眼治疗前后SFCT的比较、治疗前患眼与对侧眼SFCT的比较及治疗后患眼与对侧眼SFCT的比较，均采用配对样本t检验。 结果治疗前，患眼的CFT为(653.37±235.46)μm；治疗后1个月、2个月、3个月、4个月、5个月及6个月时，患眼的CFT分别为(342.36±136.54)μm、(265.31±94.87)μm、(253.01±181.26)μm、(313.54±102.43)μm、(251.12±98.34)μm及(226.13±70.18)μm，与治疗前比较患眼的CFT均变薄，其差异具有统计学意义(t＝8.397，11.233，9.901，9.725，11.584，12.778；P<0.05)。治疗前，患眼和对侧眼的SFCT分别为(323.27±52.24)μm和(253.26±70.13)μm；治疗后1个月、2个月、3个月、4个月、5个月及6个月时患眼的SFCT分别为(261.32±80.17)μm、(243.16±65.23)μm、(249.26±59.32)μm、(251.21±72.28)μm、(263.52±63.74)μm及(256.53±72.19)μm；对侧眼的SFCT分别为(251.34±43.26)μm、(254.27±44.16)μm、(252.64±48.27)μm、(251.67±32.89)μm、(252.45±52.36)μm及(253.79±42.57)μm。患眼治疗后1个月、2个月、3个月、4个月、5个月及6个月时的SFCT均较治疗前变薄，其差异均具有统计学意义(t＝ 4.758，7.044，6.881，5.938，5.328，5.504；P<0.05)。治疗前患眼的SFCT较对侧眼厚，其差异具有统计学意义(t＝5.883，P<0.05)。治疗后，患眼与对侧眼SFCT的比较差异均无统计学意义(t＝0.805，－1.036，－0.325，－0.043，1.134，0.240；P>0.05)。说明治疗前患眼脉络膜水肿增厚，经治疗患眼脉络膜水肿消退恢复至对侧眼的厚度。 结论继发黄斑水肿的CRVO患者脉络膜也出现水肿；玻璃体腔注射雷珠单抗在减轻黄斑视网膜水肿的同时亦可减轻脉络膜水肿。

The therapeutic effect of ranibizumab on the change of choroidal thickness in eyes with macular edema secondary to central retinal vein occlusion

ObjectiveTo investigate therapeutic effect of ranibizumab on the change of sub-foveal choroidal thickness (SFCT) in eyes with macular edema secondary to central retinal vein occlusion (CRVO). MethodsFrom November 2019 to October 2021, 54 patients (54 eyes) with macular edema secondary to CRVO received intravitreal injection of ranibizumab in the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University. Among them, there were 30 males (30 eyes) and 24 females (24 eyes) with the average age of (55.27±12.03) years-old (ranged from 25 to 71 years-old). All eyes were treated with intravitreal injection of ranibizumab. The treatment scheme was once a month for the first 3 months, and then injected as needed according to the patient′s condition after 3 months. All patients were followed up for 6 months. The foveal retinal thickness (CFT) and the macular foveal choroidal thickness (SFCT) of patients were recorded and measured before and after treatment. The data of CFT and SFCT conform to the normal distribution after inspection, and were expressed by ±s. The comparison of CFT, SFCT before and after treatment, SFCT between the affected eye and the contralateral eye before treatment, and SFCT between the affected eye and the contralateral eye after treatment were all performed by paired sample t test. ResultsBefore treatment, the CFT of the affected eye was (653.37±235.46)μm. After treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, the CFT of the affected eyes were (342.36±136.54)μm, (265.31±94.87)μm, (253.01±181.26)μm, (313.54±102.43)μm, (251.12±98.34)μm and (226.13±70.18)μm, respectively. The CFT of the affected eyes was thinner than that before treatment, and the difference was statistically significant (t=(8.397), 11.233, 9.901, 9.725, 11.584, 12.778; P<0.05). Before treatment, the SFCT of the affected eye and the contralateral eye were (323.27±52.24)μm and (253.26±70.13)μm. The SFCT of the affected eyes after treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months were (261.32±80.17)μm, (243.16±65.23)μm, (249.26±59.32)μm、(251.21±72.28)μm, (263.52±63.74)μm and (256.53±72.19)μm, respectively. The SFCT of contralateral eyes were (251.34±43.26)μm, (254.27±44.16)μm, (252.64±48.27)μ m, (251.67±32.89)μm, (252.45±52.36)μm and (253.79±42.57)μm, respectively. SFCT of the affected eye after treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months was thinner than that before treatment, and the difference was statistically significant (t=4.758, 7.044, 6.881, 5.938, 5.328, 5.504; P<0.05). Before treatment, SFCT of the affected eye was thicker than that of the contralateral eye, and the difference was statistically significant (t=5.883, P<0.05). After treatment, there was no significant difference in SFCT between the affected eye and the contralateral eye (t=0.805, -1.036, -0.325, -0.043, 1.134, 0.240; P>0.05), which indicating that before treatment, the choroidal edema of the affected eye thickened, and after treatment, the choroidal edema of the affected eye subsided and recovered to the thickness of the contralateral eye. ConclusionsThere also occurred choroidal edema in patients with macular edema secondary to CRVO, and intravitreal injection of ranibizumab could reduce macular retinal edema and choroidal edema at the same time.