抗VEGF与激光治疗非缺血性视网膜分支静脉阻塞继发黄斑水肿的临床对比研究

目的 对比玻璃体注射雷珠单抗与黄斑区格栅样光凝治疗非缺血性视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床效果及安全性.设计回顾性比较性病例系列.研究对象2015年6月至2018年6月在汉中市中心医院眼科就诊临床确诊为非缺血BRVO继发性黄斑水肿患者68例(68眼).方法 依据患者治疗情况将68例患者(68眼)分为对照组及观察组,各34例(34眼),其中对照组接受标准的黄斑区格栅样光凝治疗,观察组按需接受玻璃体注射雷珠单抗治疗.记录并比较两组治疗前、治疗后1、2、3、6个月复查时的LogMAR最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)及不良事件发生情况.主要指标BCVA、CMT及不良事件发生情况.结果 治疗前两组患者的BCVA、CMT均无统计学差异(P均>0.05).与治疗前比,治疗后1、2、3、6个月时两组BCVA(LogMAR)均显著下降(P均<0.05);且观察组治疗后1、2、3、6个月时BCVA(logMAR)均显著低于对照组(t=3.320、4.412、5.580、5.859,P均<0.05).治疗后不同时间点,两组间的CMT均存在统计学差异(F=5.603、5.122,P均<0.05),随着时间延长,两组CMT均显著下降;且观察组下降显著优于对照组(t=-8.358、-11.599、-7.792、-4.389,P均<0.05).两组均无严重不良事件发生,两组间眼内及非眼内不良事件发生率差异均无统计学意义(x2=1.063、0.216,P均>0.05).结论 玻璃体注射雷珠单抗在提高非缺血性BRVO继发黄斑水肿患者视力,降低黄斑区视网膜水肿程度方面效果均显著优于传统黄斑区格栅样光凝疗法,且安全性良好.

Clinical efficacy comparation of intravitreal injection of ranibizumab and macular photocoagulation for macular edema secondary to non-ischemic retinal branch vein occlusion

Objective To compare the clinical efficacy and safety of intravitreal injection of ranibizumab and macular photocoagulation in the treatment of macular edema secondary to non-ischemic retinal vein occlusion (BRVO). Design Retrospective comparative case series. Participants 68 patients (68 eyes) who were clinically diagnosed as non-ischemic BRVO secondary macular edema in Hanzhong Central Hospital from June 2015 to June 2018. Methods A total 68 patients (68 eyes) were divided into control group and observation group, 34 cases (34 eyes) in each group. The control group was treated with standard macular grid photocoagulation, while the observation group received intravitreal ranibizumab as needed. LogMAR best corrected visual acuity (BCVA) and central macular thickness (CMT) and adverse events in the two groups were reviewed and compared before and 1, 2, 3, and 6 months after the treatment. Main Outcome Measures BCVA, CMT and adverse events. Results There was no significant differences in LogMAR BCVA and CME between the two groups before treatment ( all P>0.05). Compared with pre-treatment, LogMAR BCVA decreased significantly at 1, 2, 3, and 6 months after treatment in two groups (all P<0.05); the LogMAR BCVA was significantly lower in the observation group than in the control group at 1, 2, 3, and 6 months after treatment (t=3.320, 4.412, 5.580, 5.859, all P<0.05). There were statistically significant differences in CMT between the two groups after treatment (F=5.603, 5.122, all P<0.05), and with the prolongation of time, the CMT of the two groups decreased significantly. The decrease in the observation group was significantly more than that in the control group (t=-8.358, -11.599, -7.792, -4.889, all P<0.05). There were no serious adverse events in both groups. There was no significant difference in the incidence of intraocular and non-intraocular adverse events between the two groups (χ2=1.063, 0.216, both P>0.05). Conclusion The effecicay of ranibizumab in improving the visual acuity and reducing the degree of macular edema of patients with non-ischemic BRVO is significantly better than that of traditional macular grid photocoagulation, and the safety is good.