玻璃体腔单独注射雷珠单抗或联合曲安奈德治疗非.doc

DOI: 10.16016/j.1000-5404. 玻璃体腔注射雷珠单抗或联合曲安奈德治疗反复或持续的CRVO-ME的对比研究 袁诗曼,刘丹宁,周希瑗 （400000重庆，重庆医科大学附属第二临床医院眼科） [摘要] 目的 对比研究玻璃体腔注射雷珠单抗(ranibizumab,R)或联合曲安奈德(triamcinolone acetonide, TA)治疗反复或持续的视网膜中央静脉阻塞继发黄斑水肿（central retinal vein obstructive macular e-dema,CRVO-ME）的有效性及安全性。方法 采用临床对照研究,收集首次行玻璃体腔注射雷珠单抗0.5mg后反复或持续的CRVO-ME患者38例(40眼), 在患者知情同意的情况下完全随机分为：R组20例(22只眼)，均行玻璃体腔注射雷珠单抗0.5mg；R+TA组18例(18只眼)，均先行玻璃体腔注射雷珠单抗0.5mg后注射曲安奈德1mg。随后根据OCT结果对患眼行按需治疗（黄斑中心凹视网膜厚度大于250μm患者行玻璃体腔重复注射）,测量2组患者治疗后1、2、3、4、5、6个月最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、眼压，每次随访行裂隙灯检眼、间接眼底镜查眼底,比较治疗前和治疗后1、2、3、4、5、6个月2组CMT与BCVA的改变情况。结果 与治疗前比较，2组治疗后1、2、3、4、5、6个月CMT及视力均有明显改善，治疗前后差异均具有统计学意义（P0.05）。2组间各项指标均无统计学差异（P0.05）。R+TA组注射次数为（2.61±0.92）次，R组注射次数为（4.05±0.65）次，2组数据间差异有统计学意义（P=0.00）。R组未见并发症，R+TA组2例出现眼压升高，1例出现皮质型白内障。结论 玻璃体腔单独注射雷珠单抗或联合曲安奈德治疗反复或持续的CRVO-ME均可减轻黄斑水肿和改善视力,但两者治疗效果无显著差异。联合治疗虽能减少注药次数，但增加了白内障青光眼的风险。 [关键词] 雷珠单抗；曲安奈德；视网膜中央静脉阻塞；黄斑水肿 [中图法分类号] [文献标志码] A [通信作者] 周希瑗, E-mail:zhouxiyuan2002@ comparative study of vitreous cavity injection ranibizumab or combined triamcinolone acetonide in the treatment of repeated or continuous CRVO-ME Yuan Shiman, Liu Danning, Zhou Xiyuan (Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University,Chongqing, 400000,China) [Abstract] Objective Comparative study the efficacy and safety of intravitreal injection ranibizumab alone or combined triamcinolone acetonide in the treatment of repeated or continuous CRVO-ME.Methods Using the controled clinical study, we collected 38 patients(40 eyes) with repeated or continuous CRVO–ME which were injected ranibizumab 0.5 mg in the vitreous cavity for the first time then it was comple-tely randomly divided as R group and R+TA group under the condition of patients′ informed consent.In R group 20 cases (22 eyes) were performed injection of ranibizumab 0.5 mg, meanwhile in R+TA group 18 cases(18 eyes) were performed vitreous injection of ranibizumab 0.5 mg and triamcinolone acetonide 1 mg.The fol