抗血管内皮生长因子与地塞米松玻璃体腔植入剂起始联合应用对视网膜中央静脉阻塞黄斑水肿外层视网膜结构完整性变化的长期观察  

Long-term observation of structural integrity changes in the outer retina of macular edema with central retinal vein occlusion after initial combination therapy of anti-vascular endothelial growth factor and dexamethasone intravitreal implantation

作　　者：叶娅 黄珍 闫明 许国仁 宋艳萍 Ye Ya;Huang Zhen;Yan Ming;Xu Guoren;Song Yanping(Department of Ophthalmology,Central Theater Command General Hospital,wuhan 430070,China)

机构地区：[1]中部战区总医院眼科,武汉430070

出　　处：《中华眼底病杂志》2024年第8期583-592,共10页Chinese Journal of Ocular Fundus Diseases

基　　金：国家重点研发计划(2022YFC2502800)。

摘　　要：目的观察抗血管内皮生长因子(VEGF)药物起始联合地塞米松玻璃体腔植入剂(DEX)对视网膜中央静脉阻塞(CRVO)继发黄斑水肿(ME)患眼黄斑区外层视网膜结构完整性的长期影响及疗效。方法回顾性临床研究。2015年2月至2022年8月于中部战区总医院眼科检查确诊的CRVO合并ME(CRVO-ME)患者54例54只眼纳人研究。其中,男性30例30只眼,女性24例24只眼;均为单眼患病。根据治疗方案的不同,将患者分为玻璃体腔注射DEX和抗VEGF药物联合治疗组(起始联合组)、单纯玻璃体腔注射抗VEGF药物组(单药组),分别为21、33只眼。患眼均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查。OCT仪测量中央视网膜厚度(CRT)以及黄斑1mm区外界膜(ELM)、椭圆体带(EZ)、嵌合体带(IZ)缺失长度。起始联合组在联合治疗后经评估按需(PRN)给予抗VEGF药物或DEX治疗;单药组接受3+PRN方案治疗。首次治疗后1、6、12个月(分别记录为V1、V6、V12)以及2023年12月观察截止点或最后一次访视(记录为Vf)采用治疗前相同的设备和方法行相关检查,对比观察两组患眼基线以及V1、V6、V12、Vf时ELM、EZ、IZ缺失长度变化。组间BCVA、CRT以及不同随访时间ELM、EZ、IZ缺失长度比较采用重复测量方差分析;两组连续变量的相关分析采用Spearman秩相关检验。结果起始联合组、单药组患者随访时间分别为(18.05±5.66)、(21.90±10.80)个月,差异无统计学意义(F=13.430,P=0.229)。与基线时比较,起始联合组、单药组患眼治疗后不同随访时间ELM、EZ、IZ缺失长度均明显改善(F=11.848、10.880、29.236),BCVA提高(F=10.541),CRT降低(F=52.278),差异均有统计学意义(P<0.001)。V1时,起始联合组、单药组EZ、IZ缺失长度分别为(344.10±413.03)、(593.33±372.96)μm和(354.71±321.75)、(604.85±385.77)μm,起始联合组EZ、IZ缺失长度改善优于单药组,差异有统计学意义(F=5.272、6.106,P=0.026、0.017);起始联合组、�Objective To observe the long-term effects of anti-vascular endothelial growth factor(VEGF)drug initiation combined with dexamethasone intravitreal implant(DEX)on the structural integrity of the outer macular region of the eye in patients with macular edema(ME)secondary to central retinal vein occlusion(CRVO).Methods A retrospective clinical study.From February 2018 to August 2022,54 patients diagnosed with CRVO combined with ME(CRVO-ME)in Department of Ophthalmology of Central Theater Command General Hospital were included in the study.Among them,there were 30 males and 24 females,all with monocular disease.According to different treatment regiments,patients were divided into anti-VEGF and DEX combination therapy group(initial combination group),anti-VEGF drug monotherapy group(monotherapy group)with 21 eyes and 33 eyes,respectively.Best corrected visual acuity(BCVA),optical coherence tomography(OCT)examination were performed in all eyes.The thickness of foveal retina(CRT)and the deficiency length of outer membrane(ELM),ellipsoid band(EZ)and chimaera band(IZ)in the 1 mm macular area were measured by OCT.The initiating combination group was treated with anti-VEGF agents or DEX as assessed on demand(PRN)after the combination therapy,and the monotherapy group received 3+PRN regimen.Relevant examinations were performed at 1(V1),6(V6),12(V12)months and observation cut-off or the last visit(Vf)after treatment using the same equipment before treatment.The deletion length of ELM,EZ and IZ in V1,V6,V12 and Vf after treatment were compared between the two groups.Repeated measurement ANOVA was used to compare BCVA,CRT and deletion length of ELM,EZ and IZ at different follow-up times.Spearman rank correlation test was used to analyze the correlation between the two groups of continuous variables.Results The follow-up time of patients in the initial combination group and monotherapy group was(18.05±5.66)and(21.90±10.80)months,respectively,with no statistical significance(F-13.430,P=0.229).Compared with baseline,the deletio

关 键 词：视网膜中央静脉阻塞 黄斑水肿 地塞米松玻璃体腔植入剂 抗血管内皮生长因子 联合治疗 

分 类 号：R774.5[医药卫生—眼科] R774.1[医药卫生—临床医学]