康柏西普治療非缺血型視網(wǎng)膜靜脈阻塞黃斑水腫療效的影響因素研究
發(fā)布時(shí)間：2018-12-10 19:26
【摘要】：目的:1觀察玻璃體腔內(nèi)注射康柏西普治療非缺血型視網(wǎng)膜靜脈阻塞合并黃斑水腫的短期臨床療效及安全性。2探求玻璃體腔內(nèi)注射康柏西普治療非缺血型視網(wǎng)膜靜脈阻塞合并黃斑水腫療效的影響因素。方法:前瞻性研究,選取2015年1月至2016年9月從出現(xiàn)自覺(jué)癥狀到就診病程小于12個(gè)月的在我院眼科就診的病例,經(jīng)過(guò)眼底檢查和眼底熒光血管造影確診為非缺血型視網(wǎng)膜靜脈阻塞合并黃斑水腫的患者。OCT檢查重點(diǎn)關(guān)注視網(wǎng)膜厚度和內(nèi)部結(jié)構(gòu)。在患者選擇和簽署知情同意后,玻璃體腔內(nèi)注射康柏西普,三組均先注射1次,隨訪時(shí)根據(jù)視力和OCT檢查變化,重復(fù)注射。治療前和治療后1、2、3、6個(gè)月常規(guī)檢查裂隙燈、眼底鏡、BCVA、OCT、眼壓變化以及末次隨訪時(shí)每只眼的總注射次數(shù)情況。應(yīng)用SPSS 21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。治療前后視力及CMT變化比較懫用t檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:共37例37只眼納入研究,男性19人,女性18人。年齡23-73歲。37只眼最佳視力(Log MAR值)0.2,最差視力(Log MAR值)1,平均0.52±0.18;黃斑囊樣水腫的囊泡高度最小為257μm,最大為873μm,平均(474.92±125.48)μm。按照性別、年齡、病程長(zhǎng)短、初始視力高低及初始黃斑水腫高度的不同,依次分組進(jìn)行研究1性別性別與視力預(yù)后療效無(wú)統(tǒng)計(jì)學(xué)意義。2年齡年齡與視力預(yù)后療效無(wú)統(tǒng)計(jì)學(xué)意義。3初診視力初診視力與視力預(yù)后療效有統(tǒng)計(jì)學(xué)意義(P值均0.05)。4初診黃斑水腫高度初診黃斑水腫高度與視力預(yù)后療效有統(tǒng)計(jì)學(xué)意義(P值均0.05)。5.1最佳矯正視力A、B、C三組治療前的BCVA與治療后各時(shí)間點(diǎn)BCVA比較,各組BCVA均有明顯的好轉(zhuǎn),差異均有統(tǒng)計(jì)學(xué)意義(P10.05;P20.05;P30.05)。5.2黃斑中心厚度A、B、C三組治療前患者的CMT與治療后各時(shí)間點(diǎn)CMT比較,各組CMT均有明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P10.05;P20.05;P30.05)。5.3治療前后最佳矯正視力差值A(chǔ)、B、C三組患者BCVA治療前與治療后1個(gè)月、3個(gè)月及6個(gè)月的差值分別為0.32±0.12、0.32±0.13及0.37±0.11;0.38±0.13、0.42±0.17及0.44±0.13;0.21±0.16、0.20±0.12及0.22±0.15。三組間治療后1個(gè)月、3個(gè)月及6個(gè)月BCVA的差值的對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(F=5.10,6.81,7.89;P0.05)。5.4治療前后黃斑中心厚度差值A(chǔ)、B、C三組患者CMT治療前與治療后1個(gè)月、3個(gè)月及6個(gè)月的差值分別為(249.86±141.57)μm、(248.14±138.43)μm及(258.00±139.91)μm;(294.64±130.03)μm、(297.00±136.50)μm及(300.18±138.52)μm;(248.33±83.85)μm、(255.75±83.84)μm及(256.08±84.16)μm。三組間治療后1個(gè)月、3個(gè)月及6個(gè)月CMT的差值的對(duì)比,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.537,0.539,0.466;P0.05)。5.5治療次數(shù)在6個(gè)月內(nèi),早期治療組(A組)的注射次數(shù)為2.29±1.27,中期治療組(B組)的注射次數(shù)為2.55±0.68,晚期治療組(C組)的注射次數(shù)為2.92±1.00,三者間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.6眼壓與治療前的眼壓相比較,三組內(nèi)的各隨訪點(diǎn)均沒(méi)有統(tǒng)計(jì)學(xué)差異。不僅如此,三組間各隨訪時(shí)間點(diǎn)的眼壓比較也沒(méi)有統(tǒng)計(jì)學(xué)差異。在隨訪期間均未觀察到高眼壓、眼內(nèi)炎、玻璃體積血及視網(wǎng)膜脫離等眼部并發(fā)癥以及嚴(yán)重的全身不良反應(yīng)。結(jié)論:1玻璃體腔內(nèi)注射康柏西普治療非缺血型RVO安全有效,短期內(nèi)能有效改善ME,進(jìn)而提高患者的視力。2病程的長(zhǎng)短、初診時(shí)視力的水平及初診時(shí)黃斑水腫高度的水平是影響RVO-ME療效的主要因素。
[Abstract]:Objective: To observe the short-term clinical efficacy and safety of the treatment of non-ischemic retinal vein occlusion combined with macular edema in vitreous cavity. Methods: A prospective study was conducted to select the cases of patients with macular edema with non-ischemic retinal vein occlusion by fundus examination and fundus fluorescein angiography from January 2015 to September 2016. The OCT examination focused on the thickness and internal structure of the retina. After the patient selected and signed the informed consent, the vitreous cavity was injected with the conifera and the three groups were first injected once, and at the follow-up, the injection was repeated according to the visual acuity and the OCT examination. The total number of injections per eye at 1, 2, 3 and 6 months before and after treatment, fundus, BCVA, OCT, IOP change, and end-time follow-up. The statistical analysis was performed using the SPSS 26.0 statistical software. The visual and CMT changes before and after treatment were compared with t-test. The difference of P0. 05 was of statistical significance. Results: 37 cases of 37 eyes were included in the study, 19 males and 18 females. Age 23-73 years. 37-eye best vision (Log MAR value) 0. 2, worst-case vision (Log MAR value) 1, mean 0.52-0.18; the vesicle height of macular edema was at least 257. m u.m, the maximum was 873. m u.m, and the average (474.92-125.48). m the initial visual acuity and the initial macular edema height are different, There was no significant difference in the efficacy of gender and visual outcome in the first group. The results of the first diagnosis of visual acuity and the prognosis of visual acuity were of statistical significance (P <0.05). The height of macular edema in the first diagnosis of macular edema was the same as that of the first diagnosis. The results of visual prognosis were statistically significant (P <0.05). The BCVA of the best corrected visual acuity A, B and C in the first group was compared with the BCVA at all time points after treatment. There was a significant improvement in BCVA in each group. The difference was statistically significant (P10.05; P20.05; P3.0. 05). The thickness of the macula was A, B, The results showed that the CMTs of the patients before and after treatment were significantly lower than that of the CMT and the time-point CMT after treatment (P10.05; P20.05; P30. 05). The best corrected corrected visual acuity was A and B before and after the treatment. The difference of BCVA before and after treatment in three groups was 0.32, 0.12, 0.32, 0.13, 0.37, 0.11, 0.38, 0.13, 0.42, 0.17 and 0.44, 0.13, 0.21, 0.16, 0.20, 0.12 and 0.22, 0.15, respectively. The difference of BCVA between 3 and 6 months after treatment was statistically significant (F = 5.10, 6.81, 7.89; P0.05). (248. 14-138.43). mu.m and (258.00-139.91). mu.m; (294.64-133.03). mu.m, (297.00-136.50). mu.m and (300,18-138.52). mu.m, (248.33-83.85). mu.m, (255.75-83.84). mu.m, and (258.08-84.16). mu.m. The number of injections in the early treatment group (group A) was 2.29 to 1.27 in the early treatment group (group A) and 2.92 to 1.00 in the late treatment group (group C). The difference between the three groups was not significant (P0.05). In addition, there was no statistically significant difference in the IOP between the three groups of follow-up time points. No ocular complications such as high intraocular pressure, endophthalmitis, vitreous hemorrhage and retinal detachment were observed during the follow-up period, as well as serious systemic adverse reactions. Conclusion: The treatment of non-ischemic RVO is safe and effective in 1 glass body cavity, and it is effective to improve the visual acuity of patients in the short term. The duration of the course, the level of visual acuity at the first visit and the level of macular edema at the first visit are the main factors that affect the efficacy of the RVO-ME.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R774
本文編號(hào)：2371081
[Abstract]:Objective: To observe the short-term clinical efficacy and safety of the treatment of non-ischemic retinal vein occlusion combined with macular edema in vitreous cavity. Methods: A prospective study was conducted to select the cases of patients with macular edema with non-ischemic retinal vein occlusion by fundus examination and fundus fluorescein angiography from January 2015 to September 2016. The OCT examination focused on the thickness and internal structure of the retina. After the patient selected and signed the informed consent, the vitreous cavity was injected with the conifera and the three groups were first injected once, and at the follow-up, the injection was repeated according to the visual acuity and the OCT examination. The total number of injections per eye at 1, 2, 3 and 6 months before and after treatment, fundus, BCVA, OCT, IOP change, and end-time follow-up. The statistical analysis was performed using the SPSS 26.0 statistical software. The visual and CMT changes before and after treatment were compared with t-test. The difference of P0. 05 was of statistical significance. Results: 37 cases of 37 eyes were included in the study, 19 males and 18 females. Age 23-73 years. 37-eye best vision (Log MAR value) 0. 2, worst-case vision (Log MAR value) 1, mean 0.52-0.18; the vesicle height of macular edema was at least 257. m u.m, the maximum was 873. m u.m, and the average (474.92-125.48). m the initial visual acuity and the initial macular edema height are different, There was no significant difference in the efficacy of gender and visual outcome in the first group. The results of the first diagnosis of visual acuity and the prognosis of visual acuity were of statistical significance (P <0.05). The height of macular edema in the first diagnosis of macular edema was the same as that of the first diagnosis. The results of visual prognosis were statistically significant (P <0.05). The BCVA of the best corrected visual acuity A, B and C in the first group was compared with the BCVA at all time points after treatment. There was a significant improvement in BCVA in each group. The difference was statistically significant (P10.05; P20.05; P3.0. 05). The thickness of the macula was A, B, The results showed that the CMTs of the patients before and after treatment were significantly lower than that of the CMT and the time-point CMT after treatment (P10.05; P20.05; P30. 05). The best corrected corrected visual acuity was A and B before and after the treatment. The difference of BCVA before and after treatment in three groups was 0.32, 0.12, 0.32, 0.13, 0.37, 0.11, 0.38, 0.13, 0.42, 0.17 and 0.44, 0.13, 0.21, 0.16, 0.20, 0.12 and 0.22, 0.15, respectively. The difference of BCVA between 3 and 6 months after treatment was statistically significant (F = 5.10, 6.81, 7.89; P0.05). (248. 14-138.43). mu.m and (258.00-139.91). mu.m; (294.64-133.03). mu.m, (297.00-136.50). mu.m and (300,18-138.52). mu.m, (248.33-83.85). mu.m, (255.75-83.84). mu.m, and (258.08-84.16). mu.m. The number of injections in the early treatment group (group A) was 2.29 to 1.27 in the early treatment group (group A) and 2.92 to 1.00 in the late treatment group (group C). The difference between the three groups was not significant (P0.05). In addition, there was no statistically significant difference in the IOP between the three groups of follow-up time points. No ocular complications such as high intraocular pressure, endophthalmitis, vitreous hemorrhage and retinal detachment were observed during the follow-up period, as well as serious systemic adverse reactions. Conclusion: The treatment of non-ischemic RVO is safe and effective in 1 glass body cavity, and it is effective to improve the visual acuity of patients in the short term. The duration of the course, the level of visual acuity at the first visit and the level of macular edema at the first visit are the main factors that affect the efficacy of the RVO-ME.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R774
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 高晶;原艷波;解瑞;于娟;高玉娟;郭倩;;玻璃體腔內(nèi)注射雷珠單抗治療非缺血型視網(wǎng)膜中央靜脈阻塞繼發(fā)黃斑水腫的臨床觀察[J];中華眼科醫(yī)學(xué)雜志(電子版);2016年04期
2 王春明;馮宇梁;李佳;張明;俞德超;;年齡相關(guān)性黃斑變性治療藥物研究進(jìn)展及未來(lái)研發(fā)方向[J];眼科新進(jìn)展;2015年06期
3 韓姬;王玲;劉偉仙;孫宏亮;蔡維;;康柏西普玻璃體腔注射對(duì)糖尿病視網(wǎng)膜病變患者視力的影響[J];中國(guó)全科醫(yī)學(xué);2015年05期
4 李常棟;朱國(guó)偉;李琳;郭喬茜;陳雪藝;;球周注射曲安奈德對(duì)兔眼周圍組織的影響[J];中華實(shí)驗(yàn)眼科雜志;2014年03期
5 孟曉麗;馮俊;;視網(wǎng)膜分支靜脈阻塞黃斑水腫的研究概況[J];中國(guó)中醫(yī)眼科雜志;2014年01期
6 丁小燕;李加青;于珊珊;吳斌斌;曾婧;劉冉;潘間英;唐仕波;;貝伐單抗治療視網(wǎng)膜中央靜脈阻塞黃斑水腫后視力恢復(fù)的預(yù)測(cè)因素分析[J];中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版);2012年01期
7 駱新瑞;鄭欽象;李文生;;視網(wǎng)膜中央靜脈阻塞的循證醫(yī)學(xué)研究進(jìn)展[J];中國(guó)實(shí)用眼科雜志;2011年02期
8 陳萍;血塞通治療視網(wǎng)膜靜脈阻塞46例療效觀察[J];中原醫(yī)刊;2003年23期
9 張惠蓉,夏英杰;視網(wǎng)膜靜脈阻塞患者視力預(yù)后相關(guān)因素分析[J];中華眼科雜志;2002年02期
，本文編號(hào)：2371081
本文鏈接：http://sikaile.net/yixuelunwen/wuguanyixuelunwen/2371081.html
最近更新
教材專著
