中华眼底病杂志

中华眼底病杂志

视网膜分支静脉阻塞继发黄斑水肿玻璃体腔注射康柏西普联合视网膜激光光凝治疗后中心凹视网膜厚度对远期视力预后的影响

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目的 观察视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)玻璃体腔注射康柏西普联合视网膜激光光凝治疗后黄斑中心凹视网膜厚度(CMT)对远期视力预后的影响。 方法 回顾性病例分析。临床检查确诊的缺血型BRVO继发ME患者41例41只眼纳入研究。其中,男性23例23只眼,女性18例18只眼。平均年龄(56.49±8.94)岁。均行最佳矫正视力(BCVA)、光相干断层扫描检查。BCVA统计时换算为最小分辨角对数(logMAR)视力。患眼平均logMAR BCVA为0.82±0.41;平均CMT为(512.61±185.32)μm。依据治疗后1个月时CMT降低值将患眼分为无应答组、应答组,分别为15例15只眼、26例26只眼。两组患者年龄、性别构成比较,差异无统计学意义(t=−0.298、−1.708,P=0.767、0.096);注药次数比较,差异有统计学意义(t=3.589,P=0.010);患眼平均logMAR BCVA、CMT比较,差异无统计学意义(t=2.056、−1.876,P=0.460、0.070)。平均随访时间8个月。将随访时间≥6个月时的logMAR BCVA定义为远期视力。观察两组患眼治疗后1、6个月CMT和远期视力变化。Pearson相关性分析远期视力与年龄、治疗前logMAR BCVA、治疗前CMT、注药次数、治疗后1个月CMT降低值的相关性。多元回归分析远期视力与年龄、性别、治疗前logMAR BCVA、治疗前CMT、注药次数、治疗后1个月CMT降低值、椭圆体带完整性、外界膜(ELM)完整性的相关性。 结果 治疗后1个月,患眼CMT较治疗前降低(231.48±177.99)μm;ELM、椭圆体带平均完整性分别为0.56±0.50、0.41±0.50。治疗后6个月,患眼平均logMAR BVCA为0.48±0.34。Pearson相关性分析结果显示,远期视力与治疗前logMAR BCVA以及治疗后1个月CMT降低值、注药次数呈正相关(P<0.05);与年龄、治疗前CMT无相关(P>0.05)。多元回归分析结果显示,远期视力与治疗前logMAR BVCA、治疗后1个月CMT降低值、ELM完整性、注药次数相关(P<0.05);与年龄、性别、治疗前CMT、椭圆体带完整性无相关(P>0.05)。治疗后6个月,无应答组、应答组患眼logMAR BCVA分别为0.86±0.23、0.26±0.14;平均CMT分别为(398.93±104.87)、(255.15±55.18)μm;平均注药次数分别为(2.53±1.46)、(1.31±0.74)次。两组患眼平均logMAR BCVA、CMT、注药次数比较,差异均有统计学意义(t=10.293、5.773、3.589,P=0.000、0.000、0.001)。所有患者均未出现与药物、玻璃体腔注射相关的并发症。 结论 缺血型BRVO继发ME玻璃体腔注射康柏西普联合视网膜激光光凝治疗后远期视力与治疗后1个月CMT降低值、外界膜完整性相关;与治疗前CMT、椭圆体带完整性无相关。

Objective To observe the effect of macular retinal thickness (CMT) on the long-term visual prognosis after intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods A retrospective non randomized controlled study. Forty-one patients (41 eyes) of ischemic BRVO secondary ME were included in the study. Among them, there were 23 males (23 eyes) and 18 females (18 eyes). The average age was (56.49±8.94) years. The best corrected visual acuity (BCVA) and optical coherence tomography were performed. The mean logMAR BCVA was 0.82±0.41, and the mean CMT was (512.61±185.32) μm. According to the CMT reduction value at 1 month after treatment, the eyes were divided into no response group and response group, each has 15 patients of 15 eyes and 26 patients of 26 eyes respectively. The age and sex composition of the two groups were not statistically significant (t=−0.298, −1.708; P=0.767, 0.096), and the difference of frequency of injection was statistically significant (t=3.589, P=0.010), and there was no statistical difference between the patients with logMAR BCVA and CMT (t=2.056, −1.876; P=0.460, 0.070). The average follow-up was 8 months. The logMAR BCVA on 6 months after treatment was defined as long term vision. The changes of long term vision and CMT on 1 and 6 months of two groups after treatment were observed. Pearson correlation analysis showed that the correlation between long-term vision and age, logMAR BCVA before treatment, CMT before treatment, frequency of injection, and CMT value decreased 1 month after treatment. The correlation of long-term visual acuity with age, sex, logMAR BCVA before treatment, CMT before treatment, number of drugs before treatment, CMT reduction at 1 month after treatment, integrity of ellipsoid band and integrity of external membrane (ELM) were analyzed by multiple regression analysis. Results On 1 month after treatment, the CMT of the eyes was lower than that before treatment (231.48±177.99) μm, and the average integrity of ELM and ellipsoid were 0.56±0.50 and 0.41±0.50 respectively. On 6 months after treatment, the average logMAR BVCA of the eyes was 0.48±0.34. The results of Pearson correlation analysis showed that the long-term vision was positively correlated with the logMAR BCVA before treatment and the number of CMT reduction and the number of drug injection at 1 month after treatment (P<0.05); there was no correlation with age and CMT before treatment (P>0.05). The results of multiple regression analysis showed that the long-term vision was associated with logMAR BVCA before treatment, CMT reduction, ELM integrity, and the number of times of injection (P<0.05), and no correlation with age, sex, CMT before treatment and the integrity of the ellipsoid (P>0.05). On the 6 months after treatment, the logMAR BCVA in the non-response group and the response group were 0.86±0.23 and 0.26±0.14, and the average CMT was respectively (398.93±104.87) and (255.15±55.18) μm, and the average injection times were respectively (2.53±1.46) and (1.31±0.74) times. The average logMAR BCVA, CMT and injection times of the two groups were statistically significant (t=10.293, 5.773, 3.589; P=0.000, 0.000, 0.001). No complications related to drug or intravitreal injection occurred in all patients. Conclusion The long-term vision of ME secondary to BRVO after intravitreal injection of Conbercept combined with retinal laser photocoagulation was associated with the decrease of CMT and the integrity of the ELM after 1 month of treatment, no correlation was found between CMT and ellipsoid integrity before treatment.

关键词: 视网膜静脉闭塞/治疗; 黄斑水肿/治疗; 血管生成抑制剂/治疗应用; 激光凝固术; 体层摄影术,光学相干

Key words: Retinal vein occlusion/therapy; Macular edema/therapy; Angiogenesis inhibitors/therapeutic use; Laser coagulation; Tomography, optical coherence

引用本文: 刘鹏辉, 孟旭霞, 周贤慧. 视网膜分支静脉阻塞继发黄斑水肿玻璃体腔注射康柏西普联合视网膜激光光凝治疗后中心凹视网膜厚度对远期视力预后的影响. 中华眼底病杂志, 2018, 34(3): 242-246. doi: 10.3760/cma.j.issn.1005-1015.2018.03.008 复制

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1. Chatziralli IP, Jaulim A, Peponis VG, et al. Branch retinal vein occlusion: treatment modalities: an update of the literature[J]. Semin Ophthalmol, 2014, 29(2): 85-107. DOI: 10.3109/08820538.2013.833271.
2. Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase Ⅲ study[J]. Ophthalmology, 2010, 117(6): 1102-1112. DOI: 10.1016/j.ophtha.2010.02.021.
3. 胡洁, 唐仕波, 梁小玲, 等.玻璃体腔单次注射抗血管内皮生长因子单克隆抗体Bevacizumab治疗糖尿病性黄斑水肿[J]. 中华眼底病杂志, 2008, 24(3): 172-175.Hu J, Tang SB, Liang XL, et al. Intravitreal injection of bevacizumab for the treatment of diabetic macular edema-a single injection outcome[J]. Chin J Ocul Fundus Dis, 2008, 24(3): 172-175.
4. 张翀, 牛彤彤.雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞继发黄斑水肿[J]. 国际眼科杂志, 2016, 16(4): 702-705.DOI: 10.3980/j.issn.1672-5123.2016.4.28.Zhang C, Niu TT.Effect of Ranibizumab with macular grid pattern photocoagulation for macular edema caused by branch retinal vein occlusion[J]. Int Eye Sci, 2016, 16(4): 702-705. DOI: 10.3980/j.issn.1672-5123.2016.4.28.
5. 蓝诚红.玻璃体腔注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞继发黄斑水肿的效果[J]. 中国当代医药, 2016, 23(17): 119-122.Lan CH.Clinical observation of intravitreal ranibizumab injection combined with grid laser photocoagulation in the treatment of macular edema secondary to branch retinal vein occlusion[J]. China Modern Medicine, 2016, 23(17): 119-122.
6. 王丽波, 周欣, 吴苏敏, 等.雷珠单抗联合激光治疗BRVO合并黄斑水肿的疗效和安全性分析[J]. 国际眼科杂志, 2017, 17(6): 1112-1115. DOI: 10.3980/j.issn.1672-5123.2017.6.26.Wang LB, Zhou X, Wu SM, et al. Efficacy and safety of ranibizumab combined with laser treatment in patients with BRVO and macular edema[J]. Int Eye Sci, 2017, 17(6): 1112-1115. DOI: 10.3980/j.issn.1672-5123.2017.6.26.
7. Eadie JA, Gottlieb JL, Ip MS, et al. Response to aflibercept in patients with persistent exudation despite prior treatment with bevacizumab or ranibizumab for age-related macular degeneration[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(5): 394-397. DOI: 10.3928/23258160-20140909-03.
8. Hara S, Sakuraba T, Kataoka H, et al. Effect of repeated intravitreal bevacizumab injections for secondary macular edema of branch retinal vein occlusion[J]. Nippon Ganka Gakkai Zasshi, 2010, 114(12): 1013-1018.
9. 沈丽君, 吴素兰.视网膜分支静脉阻塞以及继发黄斑水肿治疗现状困惑与思考[J]. 中华眼底病杂志, 2017, 33(2): 114-118. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.002.Shen LJ, Wu SL.Rethinking strategies for the treatment of branch retinal vein occlusion and secondary macular edema[J]. Chin J Ocul Fundus Dis, 2017, 33(2): 114-118. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.002.
10. 卢宁, 张承芬.视网膜中央静脉阻塞 [M]//张承芬.眼底病学.2版.北京: 人民卫生出版社, 2010: 230-231.Lu N, Zhang CF. Central retinal vein occlusion[M] Zhang CF.2 ed. Beijing: People's Medical Publishing House, 2010: 230-231.
11. 付浴东, 孟旭霞, 王大博, 等. 雷珠单抗单次玻璃体腔注射对糖尿病黄斑水肿的治疗作用[J]. 国际眼科杂, 2017, 3(17): 504-507. DOI: 10.3980/j.issn.1672-5123.2017.3.29.Fu YD, Meng XX, Wang DB, et al Therapeutic effect of single intravitreal injection of rezumab on diabetic macular edema [J]. Int Eye Sci, 2017, 3(17): 504-507. DOI: 10.3980/j.issn.1672-5123.2017.3.29.
12. Sakamoto A, Nishijima K, Kita M, et al. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247(10): 1325-1330. DOI: 10.1007/s00417-009-1107-5.
13. Amoaku WM, Chakravarthy U, Gale R, et al. Defining response to anti-VEGF therapies in neovascular AMD[J]. Eye (Lond), 2015, 29(6): 721-731. DOI: 10.1038/eye.2015.48.
14. 惠延年, 王琳, 冯学峰. 玻璃体手术和眼内光凝治疗伴玻璃体积血和新生血管膜的视网膜静脉阻塞[J]. 中华眼底病杂志, 1998, 14(1): 3-6.Hui YN, Wang L, Feng XF. Vitrectomy and intraocular photocoagulation for retinal vein occlusion with vitreous hemorrhage and neovascularization[J]. Chin J Ocul Fundus Dis, 1998, 14 (1): 3-6.
15. Wang Q, Li T, Wu Z, et al. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti-angiogenesis effect in vivo[J/OL]. PLoS One, 2013, 8(8): 70544[2013-08-12]. https://doi.org/10.1371/journal.pone.0070544. DOI: 10.1371/journal.pone.0070544.
16. Kabesha TB, Glacet-Bernard A, Rostaqui O, et al. Anti-VEGF therapy in the treatment of anterior segment neovascularization secondary to central retinal vein occlusion[J]. J Fr Ophtalmol, 2015, 38(5): 414-420. DOI: 10.1016/j.jfo.2014.11.007.
17. 丁小燕, 李加青, 于珊珊, 等.贝伐单抗治疗视网膜中央静脉阻塞黄斑水肿后视力恢复的预测因素分析[J]. 中山大学学报(医学科学版), 2012, 33(1): 79-84.Ding XY, Li JQ, Yu SS, et al. Predictive factors of visual acuity after bevacizumab treatment for macular edema after central retinal vein occlusion[J] Journal of Zhongshan University(Medical Science Edition), 2012, 33(1): 79-84.
18. 张伟, 毕大光, 谷树严.视网膜静脉阻塞激光光凝的时机选择[J]. 国际眼科杂志, 2014, 14(8): 1403-1406. DOI: 10.3980/j.issn.1672-5123.2014.08.09.Zhang W, Bi DG, Gu SY.Timing of retinal vein occlusion laser photocoagulation[J]. Int Eye Sci, 2014, 14(8): 1403-1406. DOI: 10.3980/j.issn.1672-5123.2014.08.09.
19. 刘姝林, 陈有信.抗VEGF药物治疗视网膜中央静脉阻塞并发黄斑水肿的Meta分析[J]. 中华实验眼科杂志, 2014, 32(1): 56-61. DOI: 10.3760/cma.j.issn.2095-0160.2014.01.012.Liu SL, Chen YX.Clinical effectiveness analysis of anti-VEGF for central retinal vein occlusion associated with macular edema : a Meta-analysis[J]. Chin J Exp Ophthalmol, 2014, 32(1): 56-61. DOI: 10.3760/cma.j.issn.2095-0160.2014.01.012.
20. 刘广峰, 洪婷婷, 苗森, 等. 玻璃体内注射康柏西普与黄斑区光凝治疗视网膜分支静脉阻塞继发非缺血性黄斑水肿的临床对照研究[J]. 眼科新进展, 2017(07): 658-661. DOI: 10.13389/j.cnki.rao.2017.0167.Liu GF, Hong TT, Miao S, et al. Comparison of intravitreal injection of conbercept and macular photocoagulation for non-ischemic macular edema secondary to branch retinal vein occlusion[J]. Rec Adv Ophthalmo, 2017(07): 658-661. DOI: 10.13389/j.cnki.rao.2017.0167.
21. 李琴, 张少维, 张蝶念.玻璃体腔内注射康柏西普联合532激光治疗视网膜静脉阻塞[J]. 国际眼科杂志, 2017, 17(2): 284-287. DOI: 10.3980/j.issn.1672-5123.2017.2.23.Li Q, Zhang SW, Zhang DN.Intravitreal injection of Conbercept combined with 532-laser retinal photocoagulation for retinal vein occlusion[J]. Int Eye Sci, 2017, 17(2): 284-287. DOI: 10.3980/j.issn.1672-5123.2017.2.23.
22. Theodossiadis PG, Grigoropoulos VG, Theodossiadis GP. The significance of the external limiting membrane in the recovery of photoreceptor layer after successful macular hole closure: a study by spectral domain optical coherence tomography[J]. Ophthalmologica, 2011, 225(3): 176-184. DOI: 10.1159/000323322.
23. Inoue M, Watanabe Y, Arakawa A, et al. Spectral-domain optical coherence tomography images of inner/outer segment junctions and macular hole surgery outcomes[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247(3): 325-330. DOI: 10.1007/s00417-008-0999-9.