【摘要】：目的:觀察雷珠單抗聯(lián)合視網(wǎng)膜光凝與康柏西普聯(lián)合視網(wǎng)膜光凝及單純視網(wǎng)膜光凝治療缺血型視網(wǎng)膜分支靜脈阻塞繼發(fā)黃斑水腫的療效。方法:采用回顧性隊列研究,收集黔西南州人民醫(yī)院2014年1月-2016年6月經(jīng)眼底檢查、相干光斷層掃描(OCT)、眼底熒光血管造影(FFA)確診為缺血型視網(wǎng)膜分支靜脈阻塞繼發(fā)黃斑水腫患者75例75眼,所有患者遵循自愿原則選擇治療方法,按所選的治療方法分成A、B、C三組。A組30例(30眼)為雷珠單抗聯(lián)合視網(wǎng)膜光凝組;B組24例(24眼)為康柏西普聯(lián)合視網(wǎng)膜光凝組;C組21例(21眼)為單純視網(wǎng)膜光凝組。A、B兩組于玻璃體腔注藥后1周行視網(wǎng)膜光凝治療;C組直接行視網(wǎng)膜光凝治療。首次治療后,每月隨訪查最佳矯正視力(BCVA)、OCT測量黃斑中心凹厚度(CMT),每3月復查FFA,根據(jù)BCVA、OCT及FFA檢查結(jié)果按需進行重復治療。記錄患者治療后1月、2月、3月、6月時BCVA、CMT、眼底改變及并發(fā)癥發(fā)生情況,與治療前對比,分析三組各自的療效及安全性。結(jié)果:1、BCVA(logMAR):末次隨訪,A、B、C三組BCVA(logMAR)均值與治療前相比均顯著降低,差異均有統(tǒng)計學意義(P0.05)。A組、B組、C組有效性分別為93.4%、95.8%、52.4%,A、B兩組比較,差異無統(tǒng)計學意義(P0.05)。A組與C組、B組與C組比較,差異均有統(tǒng)計學意義(P0.05)。2、CMT(μm):末次隨訪,A、B、C三組CMT均值與治療前相比均顯著降低,差異有統(tǒng)計學意義(P0.05),A組與B組比較差異無統(tǒng)計學意義(P0.05);A、B兩組CMT均值低于C組,且差異有統(tǒng)計學意義(P0.05)。3、末次隨訪,A、B、C三組FFA結(jié)果顯示治療有效性分別為93.3%、95.8%、71.4%,A組與B組比較差異無統(tǒng)計學意義(P0.05);A、B兩組療效均優(yōu)于C組,差異有統(tǒng)計學意義(P0.05)。4、注藥次數(shù)比較:平均隨訪6月,雷珠單抗聯(lián)合組與康柏西普聯(lián)合組注藥次數(shù)比較差異無統(tǒng)計學意義(P0.05)。5、并發(fā)癥情況:隨訪期間A組出現(xiàn)6例8次角膜上皮剝脫,均于玻璃體腔注藥術后第一天發(fā)生,局部使用小牛血去蛋白提取物眼用凝膠點眼治療后,3天內(nèi)癥狀消失,角膜上皮完全修復。A、B、C三組患者均未發(fā)生眼內(nèi)炎、持續(xù)性眼壓升高、醫(yī)源性白內(nèi)障以及視網(wǎng)膜脫離等嚴重并發(fā)癥。結(jié)論:1、無論是玻璃體腔注射雷珠單抗或康柏西普聯(lián)合視網(wǎng)膜光凝,還是單純視網(wǎng)膜光凝均能有效改善BRVO-ME患者的視力,降低黃斑中心厚度,且無嚴重不良反應發(fā)生。2、抗VEGF藥物聯(lián)合視網(wǎng)膜光凝治療BRVO-ME的療效比單純視網(wǎng)膜光凝更好。3、雷珠單抗或康柏西普聯(lián)合視網(wǎng)膜光凝治療BRVO-ME短期內(nèi)療效相當,兩種藥物單次注射其療效均不能長期維持。4、雷珠單抗與康柏西普玻璃體腔內(nèi)注射對黃斑水腫消退理想,為患者早期行視網(wǎng)膜光凝治療提供機會,可顯著降低因長期黃斑水腫導致的視網(wǎng)膜光感受器不可逆性損害。
[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.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.63

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