雷珠单抗联合氩激光视网膜光凝治疗不同时期的视网膜分支静脉阻塞所致黄斑水肿的疗效

目的　研究玻璃体内注射雷珠单抗联合氩激光视网膜光凝治疗不同时期的视网膜分支静脉阻塞所致黄斑水肿的临床疗效。方法　选取我院２０１３年４月至２０１５年１０月行雷珠单抗联合氩激光治疗的视网膜分支静脉阻塞所致黄斑水肿患者４６例（４６眼），患者行雷珠单抗玻璃体内注射１周后联合氩激光视网膜光凝治疗。根据视网膜分支静脉阻塞病程将患者分为３组:Ａ组:病程≤１个月（１８例）；Ｂ组:１个月＜病程≤３个月（１５例）；Ｃ组:病程＞３个月（１３例）。观察３组患者治疗前及治疗后１周、１个月、３个月、６个月时的最佳矫正视力、黄斑中心凹视网膜厚度（ｃｅｎｔｒａｌｒｅｔｉｎａｌｔｈｉｃｋｎｅｓｓ，ＣＭＴ）的改变，同时行眼底荧光血管造影检查，随诊过程中根据眼底荧光血管造影结果及时补充视网膜局部光凝治疗。结果　随诊６个月，３组最佳矫正视力组间比较表明在治疗后１周、１个月、３个月、６个月Ａ组均优于Ｂ组，Ｂ组均优于Ｃ组。３组最佳矫正视力组内比较表明Ａ组和Ｂ组最佳矫正视力在治疗后１周明显提高，Ｃ组最佳矫正视力在治疗后１个月明显提高，Ａ组至治疗后１个月时视力基本达到最佳，Ｂ组和Ｃ组至治疗后３个月时视力基本达到最佳。３组的ＣＭＴ在治疗后１周、１个月、３个月、６个月时组间差异均无统计学意义（均为Ｐ＞０．０５），３组ＣＭＴ在治疗后１周与治疗前、治疗后１个月与１周、治疗后３个月与１个月组内比较差异均有统计学意义（均为Ｐ＜０．０５），治疗后６个月与３个月组内比较差异均无统计学意义（均为Ｐ＞０．０５），即３组黄斑水肿在持续时间及程度上比较并无明显差别。结论　对于不同时期的视网膜分支静脉阻塞所致的黄斑水肿，越早进行雷珠单抗联合氩激光视网膜光凝治疗，患者的预后视力越好。

Effects of ranibizumab (Lucentis) intravitreal injection combined with retinal argon laser photocoagulation on macular edema secondary to different period of branch retinal vein occlusion

Objective To investigate the effects of ranibizumab ( Lucentis) intravitreal injection combined with retinal argon laser photocoagulation in the treatment of macular edema secondary to different period of branch retinal vein occlusion ( BRVO) . Methods The therapeutic effects of rarubizumab intravitreal injection combined with retinal argon laser photocoagulation at l week after rarubizumab intravitreal injection which performed on 46 BRVO patients (46 eyes) between April in 2013 and October in 2015 were analyzed. The patients were divided int0 3 groups according to the course of the disease. Group A (18 eyes) :The clinical course was less than l month ; Group B ( 15 eyes) :The clinical course was between l month and 3 months; Group C (13 eyes) :The clinical course was more than 3 months. The clinical data including the patients’bestcorrected visual acuity ( BCVA) and central retinal thickness ( CMT) before treatment and l week and l month,3 months,6 months after treatment were observed. According to the follow-up results of the fluorescein fundus angiography,the retinal argon laser photocoagulation was performed immediately. Results The follow-up time was 6 months. The comparison among 3 groups showed that BCVA of group A was better than that of group B and BCVA of group B were better than that of group C at l week and 1 month,3 months,6 months after treatment. The comparison within 3 groups indicated that BCVA of group A and B were significantly improved at l week after treatment, BCVA of group C was improved at l month after treatment,group A reached the BCVA at l month after treatment,and group B and C reached the BCVA at 3 months after treatment. The comparison among 3 groups showed that the differences of CMT were not sigruficant at l week and l month,3 months,6 months after treatment ( all P > 0. 05 ) . The coruparison within 3 groups indicated that the differences of CMT were statistically significant between 1 week after treatment and before treatment,l month and l week after treatment,3 months and l month after treatment ( all P < 0. 05 ) ,but not sigruficant between 6 months and 3 months after treatruent ( all P > 0. 05 ) . The results showed that there was no significant difference among 3 groups in the macular edema duration and degree. Conclusion The earlier the treatment of macular edema secondary to BRVO takes,the better the prognosis of the patients’BCVA will be.