RVO继发黄斑水肿患者雷珠单抗玻璃体腔注射后脉络膜组织形态及血流灌注变化  

Changes in choroidal morphology and blood perfusion in patients with macular edema secondary to retinal vein occlusion after intravitreal injections of ranibizumab

作　　者：祁媛媛[1] 许致玉 李春实 张智健 李胜[1] 张立军[1] Qi Yuanyuan;Xu Zhiyu;Li Chunshi;Zhang Zhijian;Li Sheng;Zhang Lijun(Department of Ophthalmology,the Third People's Hospital of Dalian,Key Laboratory of Corneal and Ocular Surface Diseases Research of Liaoning Province,Liaoning Province Branch Center of National Clinical Research Center for Eye Diseases,Dalian 116033,China)

机构地区：[1]大连市第三人民医院眼科、辽宁省角膜与眼表疾病重点实验室、国家眼部疾病临床研究中心辽宁省分中心,大连116033

出　　处：《中华实验眼科杂志》2025年第1期52-59,共8页Chinese Journal Of Experimental Ophthalmology

摘　　要：目的观察玻璃体腔注射雷珠单抗后视网膜静脉阻塞(RVO)继发黄斑水肿患者脉络膜组织形态及血流灌注的变化。方法采用队列研究方法,纳入2022年1月至2023年6月在大连市第三人民医院就诊的单眼急性期RVO继发黄斑水肿患者157例157眼,其中视网膜中央静脉阻塞(CRVO)患者66例66眼,视网膜分支静脉阻塞(BRVO)患者91例91眼,均采用雷珠单抗3+pro re nata(PRN)的方法进行治疗。分别于注射前及每次注射后1个月使用光学相干断层扫描仪(OCT)测量黄斑中心视网膜厚度;使用OCT加强深度扫描模式获得清晰的脉络膜图像,并测量黄斑中心凹下脉络膜厚度(SFCT)、黄斑中心凹鼻侧1500μm处脉络膜厚度(CT N1.5 mm)、黄斑中心凹颞侧1500μm处脉络膜厚度(CT T1.5 mm),计算黄斑中心区域平均脉络膜厚度(CT Mean);使用ImageJ软件对脉络膜图像进行二值化处理,定量分析脉络膜血管管腔面积(LA)、脉络膜基质面积(SA)、脉络膜总面积(TCA)和脉络膜血管指数(CVI)。结果RVO患眼基线SFCT、CT T1.5 mm、CT N1.5 mm、CT Mean、LA、SA、TCA、CVI均较对侧眼升高,差异均有统计学意义(均P<0.01)。CRVO组患眼基线CT Mean为(326.99±64.92)μm,大于BRVO组的(299.80±73.08)μm,差异有统计学意义(t=2.41,P=0.02);CRVO组和BRVO组基线CVI值分别为(72.50±5.62)%和(72.33±5.85)%,差异无统计学意义(t=0.187,P=0.85)。在RVO、CRVO或BRVO患者中,每次注射后SFCT、CT T1.5 mm、CT N 1.5 mm、CT Mean、LA、SA、TCA、CVI均较基线降低,差异均有统计学意义(均P<0.01)。CRVO患眼第2次注射后LA和CVI与第1次注射后比较,差异无统计学意义(均P>0.05),其余SFCT、CT T1.5 mm、CT N1.5 mm、CT Mean、SA、TCA均低于第1次注射后值,差异有统计学意义(均P<0.05);BRVO患眼第2次注射后SA和CVI与第1次注射后比较,差异无统计学意义(均P>0.05),其余SFCT、CT T1.5 mm、CT N1.5 mm、CT Mean、LA、TCA均低于第1次注射后值,差异有统计学意义(均P<0.05)。Objective To observe the changes in choroidal morphology and blood perfusion in patients with macular edema secondary to retinal vein occlusion(RVO)after intravitreal injections of ranibizumab.Methods A cohort study was performed.A total of 157 patients(157 eyes)with macular edema secondary to monocular acute retinal vein occlusion(RVO)were enrolled in the Third People's Hospital of Dalian from January 2022 to March 2023.There were 66 cases(66 eyes)with central retinal vein occlusion(CRVO)and 91 cases(91 eyes)with branch retinal vein occlusion(BRVO).All patients were treated with 3+pro re nata(PRN)regimen of ranibizumab.Before and 1 month after each injection,the central retinal thickness of the macula was measured by optical coherence tomography(OCT).Clear images of the choroid were obtained using the OCT enhanced depth scan mode.Subfoveal choroidal thickness(SFCT),the nasal choroidal thickness at 1500μm of macula(CT N1.5 mm),the temporal choroidal thickness at 1500μm of macula(CT T1.5 mm)were measured and mean macular thickness(CT Mean)was calculated.Binarization of choroidal images processed by ImageJ software was used to analyze luminal area(LA),stromal area(SA)and total choroidal area(TCA),and choroidal vascularity index(CVI)was calculated.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of the Third People's Hospital of Dalian(No.2023-145-001).Results SFCT,CT T1.5 mm,CT N1.5 mm,CT Mean,LA,SA,TCA and CVI of RVO eyes were higher than those of the contralateral eyes and the differences were statistically significant(all P<0.01).CT Mean in CRVO group was(326.99±64.92)μm,which was higher than(299.80±73.08)μm in BRVO group,with a statistically significant difference(t=2.41,P=0.02).Baseline CVI values in CRVO group and BRVO group were(72.50±5.62)%and(72.33±5.85)%,respectively,with no significant difference(t=0.187,P=0.85).In eyes with RVO,CRVO and BRVO,SFCT,CT T1.5 mm,CT N1.5 mm,CT Mean,LA,SA,TCA and CVI after every injection were lower than the baseline and the di

关 键 词：视网膜静脉阻塞 脉络膜厚度 脉络膜血流指数 雷珠单抗 抗血管内皮生长因子 

分 类 号：R774.1[医药卫生—眼科]