玻璃体腔注射雷珠单抗联合Tenon囊注射曲安奈德治疗CRVO继发黄斑水肿

目的：评价玻璃体腔注射雷珠单抗( ranibizumab)联合筋膜囊下注射曲安奈德( triamcinolone acetonide)治疗视网膜中央静脉阻塞( central retinal venous occlusions,CRVO)继发黄斑水肿( macular edema,ME)的临床疗效。方法：经眼底荧光血管造影( fundus fluorescence angiography, FFA)及光学相干断层扫描( optical coherence tomography, OCT)检查确诊为缺血型CRVO合并黄斑水肿的患者46例46眼。全部患者行全视网膜光凝( panretinal photocoagulation,PRP),经4次激光治疗结束后1wk,随机选取A组23例23眼行玻璃体腔注射雷珠单抗( IVR)治疗；B组23例23眼行IVR治疗同时行筋膜囊下注射曲安奈德( PSTT)治疗,两组间黄斑水肿程度及最佳矫正视力无显著性差异。对比分析两组治疗前,治疗后1wk；1,3,6mo 患者最佳矫正视力( best corrected visual acuity, BCVA),黄斑中心厚度( central macular thickness,CMT)的变化。结果：治疗后1 wk与治疗前相比：A组BCVA平均值提高, CMT平均值降低,差异具有统计学意义( P<0.05)；B 组BCVA平均值提高,CMT平均值亦降低,差异具有统计学意义( P<0.05),两组组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后1,3mo与治疗前相比,A组与B组BCVA平均值均提高、CMT平均值均降低,差异具有统计学意义( P<0.05),两组间比较BCVA变化、CMT变化差异具有统计学意义( P<0.05)。治疗后6 mo与治疗前相比,A组与B组BCVA平均值提高、CMT平均值降低且差异具有统计学意义(P<0.05),组间比较BCVA变化差异具有统计学意义( P<0.05)、CMT变化差异无统计学意义(P>0.05)。结论：IVR联合PSTT及单纯IVR均可有效地减轻CRVO所致黄斑水肿、提升视力；但联合治疗可以更迅速地减轻黄斑水肿,对于保护视功能起到更为积极的作用。

Intravitreal injection with ranibizumab combined with triamcinolone acetonide sub-Tenon injection for macular edema due to CRVO

AIM: To evaluate the efficacy of intravitreal injection with Ranibizumab combined with sub-Tenon injection with Triamcinolone acetonide(TA)for macular edema(ME)due to central retinal venous occlusions(CRVO).

METHODS:Forty-six patients(46 eyes)were diagnosed ischemic CRVO with significant macular edema by fundus fluorescence-angiography(FFA)and optical coherence tomography(OCT). All the patients had panretinal photocoagulation(PRP), a week after the four times therapies. Twenty-three patients(23 eyes)in group A were randomly chosen to receive intravitreal injection with ranibizumab(IVR), another 23 patients(23 eyes)in group B to treat with both IVR and sub-Tenon injection with TA(PSTT). There was no significant difference on macular edema and best corrected visual activity(BCVA)between the two groups. The changes in BCVA and central macular thickness(CMT)before and 1wk; 1, 3, 6mo after treatments were analyzed.

RESULTS: One week after the treatment: the BCVA increased while the CMT decreased compared with that of pretreatment in groups A and B(P<0.05). BCVA and CMT changes between two groups were statistically significant differences(P<0.05). One month and three months after the treatment: the BCVA increased while the CMT decreased compared with that of pretreatment in group A and B(P<0.05), the difference was significant between two groups(P<0.05). Six month after the treatment: the BCVA increased while the CMT decreased compared with that of pretreatment in groups A and B. Compare BCVA difference between the groups was statistically significant change(P<0.05), CMT difference was not statistically significant(P>0.05).

CONCLUSION: Not only IVR can decrease ME caused by CRVO and increase the BCVA, but also IVR combined with PSTT can. But combined therapies can be more rapidly and have more positive effect on decreasing the ME and protecting the visual function.