摘要
目的 对比观察康柏西普玻璃体腔注射联合黄斑格栅样激光光凝以及单纯康柏西普玻璃体腔注射和单纯黄斑格栅样激光光凝三种方法治疗非缺血型视网膜分支静脉阻塞（BRVO）继发黄斑水肿（ME）的疗效.方法 临床检查确诊的非缺血型BRVO继发ME患者90例90只眼纳入研究.其中,男性48例48只眼,女性42例42只眼;平均年龄（51.25±12.24）岁;病程5～17d.所有患眼均行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜联合前置镜、荧光素眼底血管造影、光相干断层扫描检查.按照随机排列表方法随机将患眼分为康柏西普联合黄斑格栅样激光光凝组治疗（Ⅰ组）、单纯黄斑格栅样激光光凝治疗组（Ⅱ组）、单纯康柏西普治疗组（Ⅲ组）,每组均为30只眼.Ⅰ、Ⅱ、Ⅲ组患眼之间BCVA、黄斑中心视网膜厚度（CMT）值比较,差异无统计学意义（F=0.0720、0.286,P=0.930、0.752）.接受康柏西普治疗者玻璃体腔注射康柏西普0.05 ml（含康柏西普0.5 mg）,联合激光光凝治疗者3d后给予黄斑格栅样激光光凝.单纯黄斑格栅样激光光凝者明确诊断后即进行激光光凝治疗.对比观察Ⅰ、Ⅲ组患眼玻璃体腔注射次数,Ⅰ、Ⅱ组患眼激光能量;Ⅰ、Ⅱ、Ⅲ组患眼治疗后1周,1、3、6个月BCVA、CM值的变化情况.同时观蔡与药物和治疗方式相关的眼部并发症.结果 Ⅰ组患眼平均玻璃体腔注射次数为（1.20±0.41）次,其中6只眼接受了2次玻璃体腔注射;Ⅲ组患眼平均玻璃体腔注射次数为（2.23±1.04）次,其中22只眼接受了2～4次玻璃体腔注射;两组患眼玻璃体腔注射次数比较,差异有统计学意义（P＜0.001）.Ⅱ组患眼行黄斑格栅样激光光凝平均次数为（1.43±0.63）次,其中9只眼接受2次激光光凝治疗,2只眼接受3次激光光凝治疗.Ⅰ、Ⅱ组患眼平均激光能量分别为（96.05±2.34）、（117.41±6.85） μV;两组患眼平均激光能量比较,差异有统计学意义（P=0.003）.治疗后6个月,Ⅰ、Ⅱ、Ⅲ组患眼BCVA均较治疗前提高;Ⅰ、Ⅲ组患眼BCVA明显好于Ⅱ组患眼,差异有统计学意义（t=4.607、-4.603,P＜0.001）;Ⅰ、Ⅲ组患眼之间BCVA比较,差异无统计学意义（t=-0.802,P=0.429）.治疗后1周,1个月Ⅰ、Ⅱ、Ⅲ组患眼平均CMT值分别较治疗前明显下降,差异有统计学意义（t=-11.855、-10.620、-10.254,P＜0.001）.Ⅰ、Ⅲ组患眼之间治疗后不同时间点CMT值比较,差异无统计学意义（t=0.404、1.723、-1.819、-1.755,P=0.689、0.096、0.079、0.90）;Ⅱ组患眼治疗后1周,1个月CMT值下降程度较Ⅰ组患眼低,差异有统计学意义（t=-4.621、-3.230,P＜0.001、0.003）;Ⅲ组患眼治疗后3个月CMT值较治疗后1个月增厚,但差异无统计学意义（t=1.995,P=0.056）.所有患眼治疗过程中均未发生眼内炎、虹膜红变、视网膜脱离等与药物和治疗方式相关的并发症.结论 非缺血型BRVO继发ME患眼康柏西普玻璃体腔注射联合黄斑格栅样激光光凝疗效优于单纯黄斑格栅样激光光凝治疗,并且玻璃体腔注射康柏西普的次数较单纯康柏西普玻璃体腔注射者更少.
Objective To study and compare the clinical efficacy between intravitreal conbercept injection and （or） macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion （BRVO）.Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study.Forty-eight patients （48 eyes） were male and 42 patients （42 eyes） were female.The average age was （51.25 ± 12.24） years and the course was 5-17 days.All patients were given best corrected visual acuity （BCVA）,intraocular pressure,slit lamp with preset lens,fluorescence fundus angiography （FFA） and optic coherent tomography （OCT） examination.The patients were divided into conbercept and laser group （group Ⅰ）,laser group （group Ⅱ） and conbercept group （group Ⅲ）,with 30 eyes in each group.The BCVA and central macular thickness （CMT） in the three groups at baseline were statistically no difference （F=0.072,0.286;P=0.930,0.752）.Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution （conbercept 0.5 mg）,and macular grid pattern photocoagulation 3 days later.Group Ⅱ patients were given macular grid pattern photocoagulation.Times of injection between group Ⅰ and Ⅲ,laser energy between group Ⅰ and Ⅱ,changes of BCVA and CMT among 3 groups at 1 week,1 month,3 months and 6 months after treatment were compared.Results Patients in group Ⅰ and Ⅲ had received conbercept injections （1.20 ± 0.41） and （2.23 ± 1.04） times respectively,and 6 eyes （group Ⅰ） and 22 eyes （group Ⅲ） received 2-4 times re-injections.The difference of injection times between two groups was significant （P〈0.001）.Patients in group Ⅱ had received photocoagulation （1.43 ±0.63） times,9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation.The average laser energy was （96.05 ±2.34） μV in group Ⅰ and （117.41 ±6.85） μV in group Ⅱ,the difference was statistical significant （P=0.003）.BCVA improved in all three groups at last follow-up.However,the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ （t=4.607,-4.603;P〈0.001） and there is no statistical significant difference between group Ⅲ and group Ⅰ （t=-0.802,P=0.429）.The mean CMT reduced in all three groups after treating for 1 week and 1 month,comparing that before treatment （t=-11.855,-10.620,-10.254;P〈0.001）.There was no statistical difference of CMT between group Ⅰ and Ⅲ at each follow up （t=0.404,1.723,-1.819,-1.755;P=0.689,0.096,0.079,0.900）.CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments （t=-4.621,-3.230;P〈0.001,0.003）.The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month,but the difference was not statistically significant （t=1.995,P=0.056）.All patients had no treatment-related complications,such as endophthalmitis,rubeosis iridis and retinal detachment.Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO.Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2017年第2期119-123,共5页
Chinese Journal of Ocular Fundus Diseases
基金
云南省应用基础研究计划项目（2014FB093）
云南省卫生科技计划项目（2014NS287）
