摘要
目的 对比观察康柏西普和雷珠单抗玻璃体腔注射治疗视网膜中央静脉阻塞（CRVO）黄斑水肿的疗效，初步探讨椭圆体带完整性与视力的相关性。方法 回顾性病例研究。临床检查确诊的CRVO黄斑水肿患者44例44只眼纳入研究。患者均为首次治疗。其中，男性15例15只眼，女性29例29只眼；年龄49～61岁，平均年龄（54.65±3.10）岁。均行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜、眼底彩色照相、荧光素眼底血管造影、光相干断层扫描检查。BCVA检查采用国际标准视力表，记录时换算为最小分辨角对数（logMAR）视力。依据接受治疗情况将患者分为康柏西普治疗组（A组）、雷珠单抗治疗组（B组），分别为23、21只眼。两组年龄（t=-1.41）、性别（χ2=0.55）、合并高血压患者数（χ2=0.27）、BCVA（t=-2.06）、眼压（t=-2.52）、黄斑中心凹视网膜厚度（CMT）（t=-1.96）、黄斑区椭圆体带不同完整性患眼数（χ2=1.00）、不同黄斑水肿类型患眼数（χ2=1.03）比较，差异无统计学意义（P＞0.05）。对比观察两组患眼治疗后3、6个月BCVA、CMT变化；黄斑区椭圆体带不同完整性者BCVA变化以及玻璃体腔注射次数。两组患眼治疗后6个月BCVA与治疗前BCVA、CMT相关性以及黄斑区椭圆体带不同完整性与治疗前BCVA的相关性行person、spearman相关分析。 结果 治疗后3、6个月，A、B组患眼logMAR BCVA与治疗前比较，差异均有统计学意义（tA组=5.13、7.39，t B组=6.60、11.52；P＜0.05）；两组患眼间logMAR BCVA比较，差异均无统计学意义（t=-0.99、-0.40，P＞0.05）。A、B组患眼黄斑区椭圆体带不同完整性者logMAR BCVA比较，差异有统计学意义（FA组=15.94、5.30，FB组=15.12、22.90；P＜0.05）。A、B组患眼CMT与治疗前比较，差异有统计学意义（tA组=11.58、15.96，tB组=18.77、35.16；P＜0.05）；两组患眼间CMT比较，差异无统计学意义（t=-1.52、-1.63，P＞0.05）。相关性分析结果显示，治疗后BCVA与治疗前BCVA具有相关性（r=0.44、0.62，P＜0.05）；与治疗前CMT无相关性（r=0.19、0.01，P＞0.05）。治疗前BCVA与黄斑区椭圆体带完整性具有相关性（r=0.97、0.70，P＜0.05）。A、B组患眼平均注射次数比较，差异有统计学意义（t=-6.88，P＜0.05）。所有患者均未出现眼部并发症以及全身不良反应。结论 与玻璃体腔注射雷珠单抗比较，玻璃体腔注射康柏西普治疗CRVO黄斑水肿能取得相似治疗效果，但注射次数更少；椭圆体带完整性与BCVA具有相关性。
Objective To compare the short-term efficacy of conbercept and ranibizumab for macular edema in central retinal vein occlusion （CRVO）and explore the relationship between the integrity of ellipsoidal zone and visual acuity. Methods Forty-four eyes of 44 patients with macular edema in CRVO were enrolled into this retrospective and comparative study. There were 15 eyes of 15 males, 29 eyes of 29 females; age ranged from 49 - 61 years old,with an average age of （54.65±3.10） years. All patients were examined with best-corrected visual acuity （BCVA）, intraocular pressure （IOP）, slit lamp, fundus photograph, fundus fluorescein angiography （FFA）, optical coherence tomography（OCT）. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution acuity. Twenty-three eyes were intravitreal injected with conbercept 0.5 mg （group A） and 21 eyes were intravitreal injected with ranibizumab 0.5 mg （group B）. There was no statistical difference of age （t=-1.41）, gender （χ2= 0.55）,the percentage of hypertension patients （χ2=0.27）, average BCVA （t=-2.06）, IOP （t=-2.52）, central macular thickness （CMT） （t=-1.96）, number of different integrity of ellipsoidal zone patients （χ2=1.00） and number of different types of macular edema patients （χ2=1.03） among the two groups （P〉0.05）. The change in BCVA and CMT at 3, 6 months between the two groups were compared. The relationship between BCVA at 6 months and BCVA, CMT at baseline were explored. The relationship between three groups of ellipsoidal zone and BCVA at baseline were evaluated. The change of BCVA after treatment between the three groups of ellipsoidal zone were Compared. The number of intravitreal injections between two groups was compared . Results During the 3, 6 months after treatment, the mean BCVA were all improved with statistically difference in group A （t=5.13, 7.39; P〈0.05） and group B （t=6.60, 11.52; P〈0.05）. There was no significant difference of BCVA at 3, 6 moths between group A and group B （t=-0.99, -0.40; P〉0.05）. During the 3, 6 months after treatment, the mean CMT were all decreased with statistically difference in group A （t=11.58, 15.96; P〈0.05） and group B （t=18.77, 35.16; P〈0.05）. There was no significant difference of CMT at 3, 6 months between group A and group B （t=-1.52, -1.63; P〉0.05）. In both groups,BCVA at 6 months was related to BCVA at baseline （r= 0.44, 0.62; P〈0.05）, but not related to CMT at baseline （r=0.19, 0.01; P〉0.05）. In the two groups, BCVA at baseline was related to the integrity of ellipsoidal zone （r=0.97, 0.70; P〈0.05）. There was statistical difference of the number of intravitreal injections in the two groups （t=-6.88, P〈0.05）. There was no systemic or ocular serious side effects during the follow up. Conclusions Comparing to ranibizumab, conbercept has the same effective to the treatment of macular edema in CRVO, but the number of intravitreal injections is less. The integrity of ellipsoidal zone is related to BCVA.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2016年第4期367-371,共5页
Chinese Journal of Ocular Fundus Diseases
