地塞米松玻璃体腔植入剂起始联合雷珠单抗新策略在视网膜静脉阻塞继发黄斑水肿治疗中的应用  

Application of a new strategy of initial combination therapy with intravitreal dexamethasone intravitreal implant and ranibizumab in macular edema secondary to retinal vein occlusion

作　　者：徐玥 谢驰[1] 方严[1] Xu Yue;Xie Chi;Fang Yan(Department of Ophthalmology,The First Affiliated Hospital of Anhui University of Science&Technology,Eye Institute of Anhui University of Science&Technology,Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院眼科,安徽理工大学眼科研究所,淮南232000

出　　处：《中华眼底病杂志》2022年第9期729-738,共10页Chinese Journal of Ocular Fundus Diseases

基　　金：2021年安徽省医疗卫生重点专科建设项目;2020年淮南市指导性科技计划项目(2020044)。

摘　　要：目的观察地塞米松玻璃体腔植入剂(DEX)起始联合雷珠单抗新策略治疗视网膜静脉阻塞(RVO)继发黄斑水肿(ME)(RVO-ME)的短期有效性及安全性。方法前瞻性临床干预性研究。2020年5月至2021年9月于安徽理工大学第一附属医院眼科检查确诊的RVO-ME患者78例78只眼纳入研究。其中,男性35例,女性43例;均为单眼患病。视网膜分支静脉阻塞(BRVO)40例40只眼,视网膜中央静脉阻塞(CRVO)38例38只眼。根据治疗策略,患者随机分为起始DEX和雷珠单抗联合治疗组(起始联合治疗组)、DEX治疗组、雷珠单抗治疗组,分别为29、26、23只眼。不同类型RVO分为BRVO、CRVO不同治疗方案组。所有患眼均行最佳矫正视力(BCVA)、频域光相干断层扫描检查。BCVA检查采用国际标准视力表进行,统计分析时换算为最小分辨角对数(logMAR)视力。起始联合治疗组、DEX治疗组、雷珠单抗治疗组患眼logMAR BCVA(χ^(2)=2.376)、中心凹视网膜厚度(CRT)(F=0.052)比较,差异均无统计学意义(P>0.05)。治疗后每一个月随访1次,连续6个月。观察随访期间各组患眼BCVA、CRT变化以及不良反应发生情况。差异性比较采用单因素方差分析和Kruskal-WallisH检验。结果随访期间,与基线时比较,起始联合治疗组、DEX治疗组、雷珠单抗治疗组患眼BCVA明显改善(Z=110.970、90.359、207.303),CRT明显降低(F=107.172、88.418、61.040),差异均有统计学意义(P<0.01)。治疗后1、2、3、4、5、6个月,起始联合治疗组、DEX治疗组、雷珠单抗治疗组BCVA平均变化值比较,差异均有统计学意义(χ^(2)=34.522、29.570、14.199、7.000、6.434、6.880,P<0.05);治疗后1、2、3、6个月,平均CRT变化值比较,差异均有统计学意义(F=4.313、7.520、3.699、3.152,P<0.05)。起始联合治疗组、DEX治疗组、雷珠单抗治疗组患眼BCVA改善0.1 logMAR单位所需时间分别为5.73(3.21,8.48)、9.97(6.29,18.78)、20.00(9.41,37.89)d;CRT降至300μm所需时间分�Objective To observe the short-term efficacy and safety of a new strategy of dexamethasone intravitreal implant(DEX)combined with ranibizumab in the treatment of retinal vein occlusion(RVO)secondary to macular edema(ME)(RVO-ME).Methods A prospective clinical interventional study.From May 2020 to September 2021,78 RVO-ME patients with 78 eyes diagnosed in the eye examination of Department of Ophthalmology of The First Affiliated Hospital of Anhui University of Science&Technology were included in the study.Among them,there were 35 males and 43 females,all with monocular disease.Branch retinal vein occlusion(BRVO)was found in 40 patients with 40 eyes;central retinal vein occlusion(CRVO)was found in 38 patients with 38 eyes.According to the treatment strategies,patients were randomly divided into DEX and ranibizumab combination therapy group(initial combination therapy group),DEX monotherapy group and ranibizumab monotherapy group,with 29 eyes,26 eyes and 23 eyes respectively.Different types of RVO were divided into different treatment groups of BRVO and CRVO.Best corrected visual acuity(BCVA)and frequency domain optical coherence tomography were performed.The BCVA examination was carried out using the international standard visual acuity chart,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity during statistics.There were no significant differences in logMAR BCVA(χ^(2)=2.376)and central retinal thickness(CRT)(F=0.052)among the three groups(P>0.05).After treatment,the patients were followed up every month for 6 months.The changes of BCVA,CRT and the incidence of adverse reactions were observed during follow-up.One-way ANOVA and Kruskal-Wallis H test were used to compare the differences.Results During the follow-up period,compared with the baseline,the BCVA of the eyes in the initial combination treatment group,DEX treatment group and ranibizumab treatment group were significantly improved(Z=110.970,90.359,207.303),and CRT was significantly decreased(F=107.172,88.418,61.040),the

关 键 词：视网膜静脉闭塞 黄斑水肿 地塞米松 血管生成抑制剂 玻璃体内注射 起始联合治疗 

分 类 号：R774[医药卫生—眼科]