雷珠单抗联合Ozurdex治疗视网膜分支静脉阻塞继发黄斑水肿的疗效观察

目的　通过比较地塞米松玻璃体内植入剂（Ozurdex）联合雷珠单抗与雷珠单抗单药或Ozurdex单药治疗视网膜分支静脉阻塞继发黄斑水肿（BRVO-ME）患者的疗效，评价联合用药的有效性和安全性。方法　选择2020年2月至2021年9月就诊于蚌埠医学院第一附属医院眼科的38例（38眼）BRVO-ME患者，分为雷珠单抗组（17例17眼，患者仅进行玻璃体内雷珠单抗注射），Ozurdex组（11例11眼，患者仅进行玻璃体内Ozurdex注射），联合组（10例10眼，患者先进行玻璃体内雷珠单抗注射，2周后再进行玻璃体内Ozurdex注射）。记录3组患者治疗前后最佳矫正视力（BCVA)、黄斑中心凹视网膜厚度（CMT）、眼压、注药次数，并观察术后不良反应情况。结果　与治疗前相比，雷珠单抗组和联合组治疗后1个月、2个月、3个月、4个月、6个月、12个月患者CMT均降低，BCVA均有所提高，差异均有统计学意义( 均为P<0.05）。与治疗前相比，Ozurdex组治疗后1个月、2个月、3个月、6个月、12个月患者CMT均降低，BCVA均有所提高，差异均有统计学意义(均为P<0.05），而治疗后4个月时患者BCVA与治疗前比较差异无统计学意义（P>0.05），CMT与治疗前比较差异有统计学意义（P<0.05）。与雷珠单抗组和联合组相比，Ozurdex组治疗后4个月和12个月患者CMT增加，BCVA降低，差异均有统计学意义（均为P<0.05）。治疗后1个月、2个月、3个月、4个月、6个月、12个月，雷珠单抗组与联合组患者CMT比较差异均无统计学意义（均为P>0.05）。雷珠单抗组、Ozurdex组和联合组患者注射次数分别为（7.94±1.34）次、（2.82±0.75）次和（3.78±1.20）次，雷珠单抗组与Ozurdex组和联合组相比差异均有统计学意义（均为P<0.05），而联合组与Ozurdex组相比差异无统计学意义（P>0.05）。治疗后1个月、2个月、3个月和6个月，Ozurdex组和联合组患者均出现眼压升高（均为P<0.05），其中，治疗后2个月和6个月时患者眼压升高最为显著。 Ozurdex组和联合组分别有2例2眼、1例1眼发生白内障进展，需要进行白内障手术。3组患者术后均未发生眼内炎、玻璃体积血、视网膜脱离等并发症。结论　雷珠单抗单药、Ozurdex单药和联合用药均能有效改善BRVO-ME患者黄斑水肿并提高患者视力，但雷珠单抗单药和联合用药比Ozurdex单药能更好地降低患者CMT并改善视力。同时，与雷珠单抗单药治疗相比，联合用药能减少患者注药次数，降低经济负担，而Ozurdex植入会导致更多类固醇相关副作用，特别是高眼压的发生。

Clinical effect of Ranibizumab combined with Ozurdex in the treatment of macular edema secondary to branch retinal vein occlusion

Objective　To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) combined with Ranibizumab, Ranibizumab, and Ozurdex monotherapy in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO-ME). Methods　A total of 38 patients (38 eyes) with BRVO-ME who were admitted to the Department of Ophthalmology of the First Affiliated Hospital of Bengbu Medical College from February 2020 to September 2021 were divided into the Ranibizumab group (17 patients with 17 eyes, intravitreally injected with Ranibizumab), Ozurdex group (11 patients with 11 eyes, intravitreally injected with Ozurdex), and combined group (10 patients with 10 eyes, intravitreally injected with Ranibizumab first and then Ozurdex after 2 weeks). The best corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), times of drug injection, and postoperative adverse reactions were recorded in the three groups before and after treatment. Results　At 1, 2, 3, 4, 6 and 12 months after treatment, CMT decreased and BCVA increased in the Ranibizumab and combined groups compared with the baseline, and the differences were statistically significant (all P<0.05). At 1, 2, 3, 6 and 12 months after treatment, CMT decreased and BCVA increased in the Ozurdex group compared with the baseline, and the differences were statistically significant (all P<0.05), while at 4 months after treatment, there was a significant difference in CMT (P<0.05) but no significant difference in BCVA (P>0.05) compared with the baseline. Compared with the Ranibizumab and combined groups, CMT increased and BCVA decreased in the Ozurdex group at 4 and 12 months after treatment, and the differences were statistically significant (all P<0.05). There was no significant difference in CMT between the Ranibizumab group and the combined group at 1, 2, 3, 4, 6 and 12 months after treatment (all P>0.05). The number of injections in the Ranibizumab group, Ozurdex group, and combined group were 7.94±1.34, 2.82±0.75, and 3.78±1.20, respectively. There was a significant difference between the Ranibizumab and Ozurdex groups, Ranibizumab and combined groups (all P<0.05), but no significant difference between the combined and Ozurdex groups (P>0.05). IOP in the Ozurdex and combined groups increased significantly at 1, 2, 3 and 6 months after treatment (all P<0.05), especially at 2 and 6 months. Cataract progression occurred in 2 eyes in the Ozurdex group and 1 eye in the combined group, requiring cataract surgery. There were no postoperative complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment in the three groups. Conclusion　Ranibizumab, Ozurdex, and combined therapy can effectively improve macular edema and visual acuity in patients with BRVO-ME, but Ranibizumab monotherapy and combined therapy can better reduce CMT and improve visual acuity than Ozurdex monotherapy. Compared with Ranibizumab monotherapy, combined therapy can reduce the frequency of drug injection, thus lowering costs, while Ozurdex monotherapy may lead to more steroid-related side effects, especially high IOP.