玻璃体腔注射ranibizumab治疗CRVO前后黄斑区脉络膜厚度的动态变化  

Macular choroidal thickness changes following intravitreal injection of ranibizumab for central retinal vein occlusion

作　　者：杜玉芹[1] 韩梅[1] 解士勇[1] 王莹[1] 李岩[1] 

机构地区：[1]天津医科大学眼科临床学院天津市眼科医院天津市眼科学与视觉科学重点实验室天津市眼科研究所,300020

出　　处：《中华实验眼科杂志》2016年第1期72-77,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景视网膜中央静脉阻塞（CRVO）是临床上常见的视网膜血管性疾病，目前玻璃体腔注射ranibizumab已用于CRVO继发黄斑水肿的治疗，但关于CRVO治疗前后脉络膜厚度动态变化的研究报道较少。 目的观察玻璃体腔注射ranibizumab治疗CRVO前后脉络膜厚度的变化情况。 方法采用自身对照系列病例观察性研究设计。纳入2013年6月～2014年11月在天津市眼科医院确诊的单眼非缺血型CRVO患者31例31眼，其中男19例，女12例，平均年龄（51.13±16.65）岁。所有患者均在无菌条件下玻璃体腔注射ranibizumab（5 mg，5 ml），每个月注射1次，共注射3次。分别于注射前及首次注射后1、2、3个月采用频域OCT测量仪的深度增强成像（EDI）模式对CRVO眼及对侧健眼中心凹下、距中心凹鼻侧1 mm、距中心凹颞侧1 mm处的脉络膜厚度和视网膜厚度进行测量，采用仪器中的图像分析软件进行手动测量分析，同时记录最佳矫正视力（BCVA）并转换为LogMAR视力，对患眼治疗前后的测量结果进行比较。 结果所有患眼均可见视网膜点、片形火焰状出血，FFA早期可见荧光素渗漏，晚期可见荧光素积存。患眼玻璃体腔注射ranibizumab前中心凹下脉络膜厚度值为（325.32±83.04）μm，治疗后1、2、3个月分别为（294.83±80.61）、（315.95±90.77）和（314.81±84.98）μm，治疗前和治疗后不同时间点中心凹下脉络膜厚度值的总体比较差异有统计学意义（F＝7.96，P＝0.00），治疗后各时间点中心凹下脉络膜厚度值较治疗前均明显降低，差异均有统计学意义（P＝0.01、0.01、0.00）；治疗后3个月患眼黄斑中心凹下脉络膜厚度值为（314.81±84.98）μm，较健眼的（260.47±55.90）μm明显增加，差异有统计学意义（t＝2.95，P＝0.01）。治疗前CRVO眼平均BCVA为0.17±0.09，治疗后1、2、3个月BCVA分别为0.37±0.23、0.42±0.26和0.49±0.21，治疗前及治疗�BackgroundCentral retinal vein occlusion （CRVO） is a common retinal vascular disease.Intravitreal injection of ranibizumab, a vascular endothelial growth factor （VEGF） antibody, is being a useful approach to the treatment of macular edema secondary to CRVO.However, little literature about choroidal thickness variations following intravitreal injection of ranibizumab for CRVO is published up to now. ObjectiveThis study was to observe the dynamic changes of macular choroidal thickness after intravitreal injection of ranibizumab in CRVO eyes. MethodsA self-controlled series cases study was designed.Thirty-one eyes of 31 CRVO patients were included in Tianjin Eye Hospital from June 2013 to November 2014, with the males 19 and females 12 and mean age of （51.13±16.65） years.Ranibizumab （5 mg, 5 ml） was intravitreally injected in the CRVO eyes once per month for 3 times by the same operator.A enhanced depth image （EDI） mode of spectral-domain OCT system was employed to measure the choroidal thickness at subfoveal, 1 mm from fovea nasal and 1 mm from fovea temporal before and 1 month, 2, 3 months after first injection in both CRVO eyes and contralateral healthy eyes, respectively.The best LogMAR vision was recored.This research protocol was approved by the Ethic Committee of this hospital, and written informed consent was obtained from each individual prior to any medical examination. ResultsRetinal bleeding was exhibited in the CRVO eyes in color photography, and fundus fluorescein angiography showed the fluorescine leakege in the early phase and fluorescine accummulation in the late phase.The mean choroidal theckness value was （325.32±83.04）, （294.83±80.61）, （315.95±90.77） and （314.81±84.98）μm before injection and 1, 2, 3 months after injection, respectively, showing a significantly difference among various time points （F=7.96, P=0.00）, and the choroidal theckness values were evidently reduced in various time points after injection in comparison with before injecti

关 键 词：视网膜静脉阻塞/治疗 视网膜血管内皮生长因子/拮抗剂&抑制剂 人源化单克隆抗体/治疗 玻璃体注射 脉络膜/病理 黄斑/病理 体层摄影术 光学相干断 

分 类 号：R774.1[医药卫生—眼科]