激光联合雷珠单抗或康柏西普治疗缺血型BRVO-ME的疗效观察

发布时间：2018-07-15 09:41

【摘要】：目的:观察雷珠单抗联合视网膜光凝与康柏西普联合视网膜光凝及单纯视网膜光凝治疗缺血型视网膜分支静脉阻塞继发黄斑水肿的疗效。方法:采用回顾性队列研究,收集黔西南州人民医院2014年1月-2016年6月经眼底检查、相干光断层扫描(OCT)、眼底荧光血管造影(FFA)确诊为缺血型视网膜分支静脉阻塞继发黄斑水肿患者75例75眼,所有患者遵循自愿原则选择治疗方法,按所选的治疗方法分成A、B、C三组。A组30例(30眼)为雷珠单抗联合视网膜光凝组;B组24例(24眼)为康柏西普联合视网膜光凝组;C组21例(21眼)为单纯视网膜光凝组。A、B两组于玻璃体腔注药后1周行视网膜光凝治疗;C组直接行视网膜光凝治疗。首次治疗后,每月随访查最佳矫正视力(BCVA)、OCT测量黄斑中心凹厚度(CMT),每3月复查FFA,根据BCVA、OCT及FFA检查结果按需进行重复治疗。记录患者治疗后1月、2月、3月、6月时BCVA、CMT、眼底改变及并发症发生情况,与治疗前对比,分析三组各自的疗效及安全性。结果:1、BCVA(logMAR):末次随访,A、B、C三组BCVA(logMAR)均值与治疗前相比均显著降低,差异均有统计学意义(P0.05)。A组、B组、C组有效性分别为93.4%、95.8%、52.4%,A、B两组比较,差异无统计学意义(P0.05)。A组与C组、B组与C组比较,差异均有统计学意义(P0.05)。2、CMT(μm):末次随访,A、B、C三组CMT均值与治疗前相比均显著降低,差异有统计学意义(P0.05),A组与B组比较差异无统计学意义(P0.05);A、B两组CMT均值低于C组,且差异有统计学意义(P0.05)。3、末次随访,A、B、C三组FFA结果显示治疗有效性分别为93.3%、95.8%、71.4%,A组与B组比较差异无统计学意义(P0.05);A、B两组疗效均优于C组,差异有统计学意义(P0.05)。4、注药次数比较:平均随访6月,雷珠单抗联合组与康柏西普联合组注药次数比较差异无统计学意义(P0.05)。5、并发症情况:随访期间A组出现6例8次角膜上皮剥脱,均于玻璃体腔注药术后第一天发生,局部使用小牛血去蛋白提取物眼用凝胶点眼治疗后,3天内症状消失,角膜上皮完全修复。A、B、C三组患者均未发生眼内炎、持续性眼压升高、医源性白内障以及视网膜脱离等严重并发症。结论:1、无论是玻璃体腔注射雷珠单抗或康柏西普联合视网膜光凝,还是单纯视网膜光凝均能有效改善BRVO-ME患者的视力,降低黄斑中心厚度,且无严重不良反应发生。2、抗VEGF药物联合视网膜光凝治疗BRVO-ME的疗效比单纯视网膜光凝更好。3、雷珠单抗或康柏西普联合视网膜光凝治疗BRVO-ME短期内疗效相当,两种药物单次注射其疗效均不能长期维持。4、雷珠单抗与康柏西普玻璃体腔内注射对黄斑水肿消退理想,为患者早期行视网膜光凝治疗提供机会,可显著降低因长期黄斑水肿导致的视网膜光感受器不可逆性损害。
[Abstract]:Aim: to observe the effect of combined retinal photocoagulation with Retinal photocoagulation combined with Retinal photocoagulation and Retinal photocoagulation alone in the treatment of macular edema secondary to ischemic retinal branch vein occlusion. Methods: retrospective cohort study was used to collect fundus examinations from January 2014 to June 2016 in Qianxinan people's Hospital. Coherence tomography (Oct) and fundus fluorescein angiography (FFA) were used to diagnose 75 patients with macular edema secondary to ischemic retinal branch vein occlusion. According to the selected treatment method, 30 cases (30 eyes) in group A were divided into group A (30 eyes) and group B (24 eyes), group B (24 eyes): Compactopril combined with retinal photocoagulation group (group C, 21 cases (21 eyes): retinal photocoagulation group (group A, n = 21), simple retinal photocoagulation group, group A (n = 20), retinal photocoagulation group (group B, n = 24), simple retinal photocoagulation group (n = 21, n = 21). The two groups were treated with retinal photocoagulation one week after intravitreal injection. After the first treatment, the best corrected visual acuity (BCVA) Oct was used to measure the thickness of foveal fovea (CMT). The FFAs were reexamined every 3 months, and repeated treatment was performed according to the results of BCVA Oct and FFA. The changes of ocular fundus and the occurrence of complications were recorded at 1 month, 2 months, 3 months and 6 months after treatment. The efficacy and safety of the three groups were compared with those before treatment. Results BCVA (logMAR): the mean value of BCVA (logMAR) in the last follow-up group was significantly lower than that before treatment (P 0.05). The effectiveness of group A was 93.4% 95. 8%. There was no significant difference between group A and group C (P0.05), and there was no significant difference between group A and group C (P 0.05), and there was no significant difference between group A and group C (P 0.05). The difference was statistically significant (P0.05). 2CMT (渭 m): the mean value of CMT in group A was significantly lower than that in group C (P0.05), and there was no significant difference between group A and group B (P0.05). The mean value of CMT in group A and group B was lower than that in group C (P0.05), and the mean value of CMT in group A was lower than that in group C (P0.05), and the mean value of CMT in group A was lower than that in group C (P0.05). And the difference was statistically significant (P0.05). 3. The results of FFA in the last follow-up group showed that the efficacy of FFA in group A was 93.30.95. 8 and that in group A was 71.4. There was no significant difference between group A and group B (P0.05). The curative effect of group A was better than that of group C (P 0.05), and that of group B was better than that of group C (P 0.05). The difference was statistically significant (P0.05). 4. Comparison of the times of injection: the average follow-up was 6 months. There was no significant difference in the number of times of injection between the combined group of Lei Zhu McAb and the group of Compactopril (P0.05) .5The complications: during the follow-up period, 6 cases of corneal epithelium exfoliation occurred in group A, all of them occurred on the first day after vitreous injection. The symptoms disappeared within 3 days after local use of calf blood deproteinizing extract (BGE), and no endophthalmitis and persistent intraocular pressure were found in the three groups of patients with complete corneal epithelium repair. Iatrogenic cataract and retinal detachment and other serious complications. ConclusionThe vitreous injection of Leizhu McAb, Combortopril combined with retinal photocoagulation or retinal photocoagulation alone can effectively improve the visual acuity and decrease the central macular thickness in BRVO-ME patients. There were no serious adverse reactions. The therapeutic effect of anti-VEGF drugs combined with retinal photocoagulation was better than that of retinal photocoagulation alone. The therapeutic effect of Razumab or Comborsup combined with retinal photocoagulation on BRVO-ME was similar in the short term. The efficacy of single injection of both drugs could not be maintained for a long period of time. Threzumab and Compacipe intravitreal injection were ideal for macular edema regression, which provided an opportunity for early retinal photocoagulation therapy in patients with macular edema. The irreversibility damage of retinal photoreceptor caused by long-term macular edema can be significantly reduced.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.63

【相似文献】