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目的探讨玻璃体注射雷珠单抗治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿的效果。设计前瞻性比较性病例系列。研究对象46例CRVO继发黄斑水肿患者(46眼)。方法采用随机分层法分为对照组(n=23例,予以玻璃体注射4 mg/0.1ml曲安奈德)和观察组(n=23例,玻璃体注射0.5 mg/0.05ml雷珠单抗)。于治疗后1、4、8、12、24周,观察治疗效果。主要指标最佳矫正视力(BCVA),黄斑中心凹厚度(CMT),眼压。结果(1)治疗后1、4、8、12、24周,两组患者视力改善有效率对比差异无统计学意义(P=0.760、0.765、0.552、0.767、0.555);(2)两组患者不同时间点BCVA组内比较差异均有统计学意义(F=4.373,P=0.000;F=3.472,P=0.008)。在各时间点上,两组患者BCVA比较差异无统计学意义(P=1.000、0.339、0.484、0.886、0.502、0.560);(3)两组患者不同时间点CMT组内比较差异均存在统计学意义(F=3.891,P=0.000;F=3.571,P=0.002)。在各时间点上,两组患者CMT比较差异无统计学意义(P=0.855、0.869、0.915、0.892、0.874、0.564)。(4)观察组不同时间点眼压比较差异无统计学意义(F=2.341,P=0.137),对照组组内比较差异有统计学意义(F=2.569,P=0.049)。在治疗后4周和24周,观察组患者眼压值明显低于对照组(P=0.008、0.042),其余时间点,两组患者眼压值差异无统计学意义(P=0.216、0.161、0.242)。(5)在随访过程中,对照组患者出现2例(8.70%)眼压升高,观察组患者未出现其他并发症。结论玻璃体注射雷珠单抗治疗CRVO继发黄斑水肿效果较好,在提高BCVA及降低CMT方面与曲安奈德相当,但在避免眼压升高方面优于曲安奈德,治疗安全性较高。
Objective To investigate the effect of vitreous injection of ranibizumab on secondary macular edema in patients with central retinal vein occlusion (CRVO). Design prospective comparative case series. Forty-six patients with macular edema secondary to CRVO were studied (46 eyes). Methods The patients were randomly divided into control group (n = 23, intravitreal injection of 4 mg / 0.1ml triamcinolone acetonide) and observation group (n = 23, intravitreal injection of 0.5 mg / 0.05ml ranibizumab). At 1, 4, 8, 12 and 24 weeks after treatment, the therapeutic effect was observed. The main indicators of best corrected visual acuity (BCVA), macular foveal thickness (CMT), intraocular pressure. Results (1) At 1, 4, 8, 12 and 24 weeks after treatment, there was no significant difference in visual acuity improvement between the two groups (P = 0.760,0.765,0.552,0.767,0.555); (2) There were significant differences in BCVA group at different time points (F = 4.373, P = 0.000; F = 3.472, P = 0.008). At each time point, there was no significant difference in BCVA between the two groups (P = 1.000,0.339,0.484,0.886,0.502,0.560); (3) There were statistically significant differences in CMT between two groups at different time points Significance (F = 3.891, P = 0.000; F = 3.571, P = 0.002). At each time point, there was no significant difference in CMT between the two groups (P = 0.855,0.869,0.915,0.892,0.874,0.564). (4) There was no significant difference in intraocular pressure in the observation group at different time points (F = 2.341, P = 0.137). There was significant difference in the control group (F = 2.569, P = 0.049). At 4 weeks and 24 weeks after treatment, the intraocular pressure in the observation group was significantly lower than that in the control group (P = 0.008,0.042). At the other time points, there was no significant difference in intraocular pressure between the two groups (P = 0.216, 0.161, 0.242). (5) During the follow-up, two patients (8.70%) in the control group showed an increase in intraocular pressure and no other complication occurred in the observation group. Conclusion Intravitreal injection of ranibizumab is superior to triamcinolone acetonide in the treatment of CRVO secondary macular edema, but it is superior to triamcinolone acetonide in preventing intraocular pressure elevation and has higher safety.