康柏西普玻璃体腔注射联合曲安奈德后Tenon囊下注射对非缺血型BRVO继发黄斑水肿的疗效评估  

Evaluation of efficacy of combination therapy of intravitreal conbercept with posterior sub-Tenon triamcinolone acetonide for treatment of macular edema secondary to non-ischemic branch retinal vein occlusion

作　　者：解瑞[1] 原丽[2] Xie Rui;Yuan Li(Department of Ophthalmology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China;Department of Physiology,Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院眼科,长治046000 [2]长治医学院生理学教研室,长治046000

出　　处：《中华实验眼科杂志》2022年第12期1149-1156,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：山西省自然科学基金项目(20210302124324);山西省卫生健康委员会科研课题项目(2019136、2020135);山西省高等学校科技创新项目(2017166);长治医学院博士启动基金项目(BS17001)。

摘　　要：目的评估康柏西普玻璃体腔注射(IVC)联合曲安奈德后Tenon囊下注射(PSTA)治疗非缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床疗效。方法采用非随机对照临床研究,纳入2016年10月至2019年11月于长治医学院附属和平医院眼科就诊的单眼非缺血型BRVO继发黄斑水肿患者59例59眼,根据注射药物不同分为IVC组28眼和IVC+PSTA组31眼。IVC组采用1+按需(PRN)方案给予IVC治疗,IVC+PSTA组首次治疗给予IVC联合PSTA治疗,之后按PRN方案仅予以IVC治疗。比较2个组注射前和注射后1、3、6个月最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、眼压变化及重复注射次数,观察2个组眼部并发症。结果2个组BCVA组间总体比较差异无统计学意义,不同时间点BCVA总体比较差异有统计学意义(F_(分组)=0.464,P=0.498;F_(时间)=25.454,P<0.001),2个组注射后不同时间点BCVA均较注射前明显提高,差异均有统计学意义(均P<0.001)。2个组注射前后不同时间点CMT总体比较差异均有统计学意义(F分组=6.208,P=0.016;F时间=155.505,P<0.001),2个组注射后不同时间点CMT均较注射前明显降低,注射后1个月和3个月IVC+PSTA组CMT值小于IVC组,差异均有统计学意义(均P<0.05)。2个组眼压总体比较差异有统计学意义,不同时间点眼压比较差异无统计学意义(F_(分组)=9.994,P=0.006;F_(时间)=2.679,P=0.056),其中注射后1个月和3个月IVC+PSTA组眼压高于IVC组,差异均有统计学意义(均P<0.01);IVC+PSTA组有4眼眼压>21 mmHg(1 mmHg=0.133 kPa)。6个月随访期内,IVC组平均重复注射(1.25±0.93)次,多于IVC+PSTA组的(0.61±0.72)次,差异有统计学意义(P=0.039)。2个组患者均未见其他眼部并发症。结论IVC联合PSTA可明显改善非缺血型BRVO患者的视力和黄斑水肿程度,单次PSTA早期可强化康柏西普缓解黄斑水肿的作用,短期内减少康柏西普重复注射次数。Objective To evaluate the efficacy of combination therapy of intravitreal conbercept(IVC)with posterior sub-Tenon injection of triamcinolone acetonide(PSTA)in treating macular edema secondary to non-ischemic branch retinal vein occlusion(BRVO).Methods A nonrandomized controlled study was conducted.Fifty-nine patients(59 eyes)diagnosed with macular edema secondary to non-ischemic BRVO were enrolled in Heping Hospital Affiliated to Changzhi Medical College from October 2016 to November 2019.The subjects were divided into IVC group(28 eyes)and combination therapy of IVC with PSTA group(IVC+PSTA group for short)(31 eyes).IVC group received IVC 0.5 mg and IVC+PSTA group received IVC 0.5 mg combined with PSTA 40 mg as the initial therapy,then a pro re nata(PRN)IVC administration was adopted for the two groups.The mean best corrected visual acuity(BCVA)converted to the logarithm of the minimum angle of resolution unit,central macular thickness(CMT)and intraocular pressure(IOP)before and 1,3,6 months after injection were measured and compared.The number of repeated IVC injections and relevant complications were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Heping Hospital Affiliated to Changzhi Medical College(No.20160R9).Written informed consent was obtained from each subject prior to any medical examination.Results There was a statistically significant difference in BCVA between the two groups among different time points(F group=0.464,P=0.498;F time=25.454,P<0.001).Compared with before injection,the BCVA of both groups was significantly improved at each time point after injection(all at P<0.001).There was a statistically significant difference in CMT between the two groups among different time points(F group=6.208,P=0.016;F time=155.505,P<0.001).The CMT of both groups at each time point after injection was significantly smaller than that before injection,and the CMT in IVC+PSTA group at 1 and 3 months after injection was smaller than that in IVC gr

关 键 词：视网膜静脉阻塞 黄斑水肿 康柏西普 曲安奈德 后TENON囊下注射 

分 类 号：R774.5[医药卫生—眼科]