摘要
目的探讨首次注射康柏西普后激光治疗时机选择对缺血型视网膜静脉阻塞(retinal vein occlusion,RVO)继发黄斑水肿(macular edema,ME)治疗时长的影响及远期效果。方法选取2017年9月至2018年12月RVO-ME患者156例156只眼,采用随机数字表法分为A组、B组和C组,每组患者各52例52只眼,三组均采取激光治疗联合玻璃体腔内注射康柏西普治疗,在康柏西普1次注射后采用“康柏西普1+PRN(Pro Re Nata)”方案,其中A组康柏西普注射后1个月内进行激光光凝;B组康柏西普注射后1~3个月内进行激光光凝;C组康柏西普注射3个月后进行激光光凝。治疗前、治疗后3个月、治疗后12个月、末次随访时,比较三组患者远距离最佳矫正视力(best corrected visual acuity,BCVA)以及黄斑中心凹厚度(central macular thickness,CMT)改变,分析三组患者的终点治疗时间、玻璃体注药次数以及用药期间不良反应或并发症发生情况。结果各组患者治疗前BCVA、CMT差异无统计学意义(P>0.05),治疗后3个月和12个月、末次随访时,三组患者BCVA均明显高于治疗前;三组治疗后CMT均显著变薄(P<0.01),但三组间比较差异无统计学意义(P>0.05)。三组患者均达到治疗终点,随诊时间(20.4±3.6)个月,三组患者终点治疗时间和玻璃体注药次数差异均具有统计学意义(P<0.001),其中A组终点治疗时间和玻璃体注药次数少于B组和C组,B组少于C组(P<0.001)。治疗和随访期间,A组和B组患者均未发生视网膜、脉络膜脱离、玻璃体出血以及眼内炎等并发症和其他心脑血管疾病等全身性不良反应,但C组有2例患者发生继发新生血管性青光眼。结论首次注射康柏西普后激光治疗时机选择不同将影响缺血型RVO-ME治疗时长和玻璃体腔注射康柏西普次数,临床应用时可考虑尽早开始联合激光治疗。
Objective To explore the effect of the choice of time for laser treatment after the first injection of Conbercept on the treatment duration and long-term effect of the macular edema(ME)secondary to ischemic retinal vein occlusion(RVO).Methods Totally 156 patients(156 eyes)with RVO-ME admitted during the period from Sep.2017 to Dec.2018 were selected and divided randomly into three groups:group A,B and C,52 cases(52 eyes)in each group.All the patients were given a combined treatment of laser and Conbercept,and the"Conbercept 1+PRN(Pro Re Nata)"regimen was used after one injection of Conbercept.The patients in group A,B and C were given laser photocoagulation respectively within a month,during 1-3 months and 3 months upon the injection of Conbercept.The best corrected visual acuity(BCVA)and central macular thickness(CMT)of the three groups of patients before the treatment,3 and 12 months after the treatment and at the last follow-up were compared respectively,and the end point of treatment time,number of vitreous injections and occurrence of adverse reactions or complications during medication of the three groups were recorded and compared.Results There was no statistically significant difference in BCVA and CMT between the groups of patients before the treatment(P>0.05).At 3,12 months after treatment,and last follow-up time,for all the three groups,the patients’BCVA of the three groups of patients was significantly improved compared to before treatment 3 and 12 months after the treatment and at the last follow-up,and their CMT was reduced significantly thinner(P<0.01).However,but the differences between among the three groups were not statistically significant(P>0.05).The three groups of patients all reached the treatment node,and the follow-up time was(20.4±3.6)months of patients.There were statistically significant differences in the end point treatment time and the number of vitreous injections in the three groups(P<0.001).Among them,the end point treatment time and the number of vitreous injections in group A were less than those in groups B and C,and group B was less than that in group C(P<0.001).During the treatment and follow-up period,the patients in groups A and B did not suffer from complications such as retinal,choroidal detachment,vitreous hemorrhage,endophthalmitis,and other cardiovascular and cerebrovascular diseases,but there were 2 patients in group C developed secondary neovascular glaucoma.Conclusions The choice of the time for laser treatment after the first injection of Conbercept will affect the treating duration of ischemic RVO-ME and the number of intravitreal injections of Conbercept required.Clinically,it is suggested to start the combined laser treatment as soon as possible.
作者
杨维佳
贾俊
刘慧峰
万鹏飞
YANG Weijia;JIA Jun;LIU Huifeng;WAN Pengfei(Department of Ophthalmology,The Second Affiliated Hospital of Xi'an Medical University,Xi'an 710038,China)
出处
《中国激光医学杂志》
CAS
2022年第6期329-334,共6页
Chinese Journal of Laser Medicine & Surgery
作者简介
杨维佳(1984-),男,广西贺州市人,主治医师,主要从事眼底病的研究;通信作者:万鹏飞。
