Ranibizumab玻璃体腔注射后糖尿病黄斑水肿患者中心视网膜厚度相对变化与视力预后的关系  被引量:18

The relationship between central retinal thickness relative change and visual prognosis in diabetic macularedema patients following intravitreal injection of ranibizumab

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作  者:韩月圣 魏文斌[1] 

机构地区:[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出  处:《中华实验眼科杂志》2016年第1期78-84,共7页Chinese Journal Of Experimental Ophthalmology

基  金:国家自然科学基金项目(81272891);北京市自然科学基金项目(7112031、7092021)

摘  要:背景抗VEGF药物ranibizumab玻璃体腔注射治疗糖尿病黄斑水肿(DME)的相关研究均以治疗前后中心视网膜厚度(CRT)绝对改变(ACRT)进行分析,而对治疗后CRT相对于治疗前CRT(RCRT)或治疗前增厚的CRT减少程度(RCRTing)即相对变化量的研究较少。 目的探讨DME患者行ranibizumab玻璃体腔注射后RCRT、RCRTing在视力预后判断中的作用。 方法采用自身对照系列病例观察研究设计,于2013年11月至2014年10月在中国核工业北京四〇一医院眼科确诊的30例30眼临床显著糖尿病黄斑水肿(CSDME)患者,所有患眼均用30 G注射针头于颞下方角膜缘后3.5 mm处进入玻璃体腔,注射10 mg/ml的ranibizumab注射液0.05 ml。分别于治疗前和治疗后3、6个月,利用ETDRs改良视力表测定2.5 m处的最佳矫正视力(BCVA)(LogMAR),计算治疗前与治疗后6个月BCVA绝对变化值(ABCVA);采用SD-OCT检测系统测量CRT黄斑中心直径1.0 mm处的CRT,计算治疗后6个月患眼的RCRT、RCRTing值,分析RCRT、RCRTing与ABCVA间的关系。 结果CSDME患者治疗前及治疗后3、6个月BCVA分别为(0.66±0.20)、(0.40±0.25)、(0.37±0.25)LogMAR,治疗前后BCVA比较差异有统计学意义(F=36.79,P〈0.05),其中治疗后各时间点与治疗前比较视力明显改善,差异均有统计学意义(均P〈0.05),患眼的ABCVA为(0.30±0.21)LogMAR。治疗前、治疗后3、6个月CRT值分别为(508.63±130.44)、(331.07±71.84)和(311.77±64.47)μm,治疗前及治疗后不同时间点间CRT的总体比较差异有统计学意义(F=49.78,P〈0.05),治疗后各时间点患眼的CRT值较治疗前均明显下降,差异均有统计学意义(均P〈0.05),患眼ACRT值为(196.87±140.59)μm。RCRT〈35%组和RCRT≥35%组患者的ABCVA分别为(0.13±0.13)、(0.44±0.14)LogMAR;RCRTing〈69%组和RCRTing≥69%组患者ABCVA分别为(0.07±0.09)、(0.41±0.1BackgroundThe studies on intravitreal ranibizumab for diabetic macular edema (DME) primarily focuses on the absolute change of central retinal thickness, while the affection of the relative change of central retinal thickness (RCRT) or relative change of central retinal thickening (RCRTing) on visual prognosis has not been elucidated completely. ObjectiveThis study aimed to evaluate the effect of RCRT and RCRTing in assessing visual prognosis in DME patients following intravitreal injection of ranibizumab. MethodsA self-controlled observational study was designed.Thirty eyes of thirty patients with clinically significant DME (CSDME) were recruited in Beijing 401 Hospital of China Nuclear Industry from November 2013 to October 2014.Ranibizumab of 0.05 ml (10 mg/ml) was intravitreally injected by 30G syringe needle at 3.5 mm posterior corneal limbus.Best corrected visual acuity (BCVA) far 2.5 meters away modified ETDRs visual chart was examined before injection and 3 and 6 months after injection, and the BCVA difference value between before injection and 6 months after injection was calculated as the absolusion BCVA (ABCVA). Spectral domian optical coherence tomography (SD-OCT) system was employed to measure the central retinal thickness (CRT) and to calculate the RCRT and RCRTing value.The correlations of RCRT or RCRTing with ABCVA was analyzed. ResultsThe LogMAR values were (0.66±0.20), (0.40±0.25)BCVA and (0.37±0.25) before injection and 3, 6 months after injection respectively in the CSDME patients, with a significant difference among them (F=36.79, P〈0.05). The values were obviously improved 3 and 6 months after injection compared with before injection (both at P〈0.05). The mean ABCVA (LogMar) of the patients was (0.30±0.21). The CRT 3, 6 , pmyjd sgyrt omkrvyopm values were (508.63±130.44), (331.07±71.84) and (311.77±64.47)μm before injection and respectively in the CSDME patients, showing a significant difference

关 键 词:糖尿病视网膜病变/药物疗法 黄斑水肿/治疗 中心视网膜厚度 视力 人源化单克隆抗体 体层摄影术 光学相干 玻璃体 

分 类 号:R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]

 

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