[1]马恒哲.雷珠单抗对视网膜分支静脉阻塞继发黄斑水肿患者视网膜血流密度的影响[J].眼科新进展,2021,41(9):874-878.[doi:10.13389/j.cnki.rao.2021.0183]
　MA Hengzhe.Effect of ranibizumab on the density of retinal blood flow in patients with macular edema secondary to branch retinal vein occlusion[J].Recent Advances in Ophthalmology,2021,41(9):874-878.[doi:10.13389/j.cnki.rao.2021.0183]
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雷珠单抗对视网膜分支静脉阻塞继发黄斑水肿患者视网膜血流密度的影响/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年9期
页码:
874-878
栏目:
应用研究
出版日期:
2021-09-05

文章信息/Info

Title:
Effect of ranibizumab on the density of retinal blood flow in patients with macular edema secondary to branch retinal vein occlusion
作者:
马恒哲
471000　河南省洛阳市，洛阳市第三人民医院眼科
Author(s):
MA Hengzhe
Department of Ophthalmology,Luoyang Third People’s Hospital,Luoyang 471000,Henan Province,China
关键词:
视网膜分支静脉阻塞; 黄斑水肿; 雷珠单抗; 光学相干断层扫描血流成像; 视网膜毛细血管丛
Keywords:
branch retinal vein occlusion;  macular edema;  ranibizumab;  optical coherence tomography angiography;  retinal capillary plexus
分类号:
R774
DOI:
10.13389/j.cnki.rao.2021.0183
文献标志码:
A
摘要:
目的　探讨雷珠单抗对视网膜分支静脉阻塞（BRVO）继发黄斑水肿患者视网膜深层和浅层血流密度的影响。方法　选取2019年7月至2020年7月洛阳市第三人民医院眼科收治的BRVO继发黄斑水肿患者62例（62眼）作为病例组，同期以年龄、性别等为匹配条件选取健康者36人（36眼）作为对照组。采用OCTA扫描模式对两组受试者黄斑区视网膜浅层毛细血管丛（SVC）血流密度、深层毛细血管丛（DVC）血流密度、黄斑中心凹无血管区域（FAZ）面积、FAZ周长、非圆度指数（AI）及FAZ范围300 μm宽度内的血流密度（FD-300）等参数进行测量。病例组患者接受玻璃体内注射雷珠单抗治疗，连续治疗3个月（每月注射1次），治疗后随访6个月，观察治疗后1个月、3个月、6个月病例组患者各项视网膜血流参数及最佳矫正视力（BCVA）。采用Pearson相关性分析法分析病例组患者治疗后的BCVA与各项视网膜血流参数的相关性。结果　治疗前病例组患者SVC血流密度、旁中心凹SVC血流密度、DVC血流密度、旁中心凹DVC血流密度、FD-300均小于对照组，差异均有统计学意义（均为P<0.05）；治疗前病例组患者黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度、FAZ面积、FAZ周长、AI均大于对照组，差异均有统计学意义（均为P<0.05）。与治疗前相比，病例组患者治疗后1个月、3个月、6个月的黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度均降低，差异均有统计学意义（均为P<0.05）；与治疗前相比，病例组患者治疗后3个月、6个月的FAZ面积均增加，差异均有统计学意义（均为P<0.05）；与治疗后1个月相比，病例组患者治疗后6个月的FAZ面积增加，差异有统计学意义（P<0.05）；与治疗前相比，病例组患者治疗后1个月、3个月、6个月的AI均降低，差异均有统计学意义（均为P<0.05）；病例组患者BCVA随治疗时间的延长逐渐改善，不同时间点两两比较，差异均有统计学意义（均为P<0.05）。治疗后6个月病例组患者BCVA与黄斑中心凹SVC血流密度、黄斑中心凹DVC血流密度、AI均呈正相关性（r=0.341、0.339、0.308，P=0.013、0.015、0.042），BCVA与FAZ面积呈负相关性（r=-0.337，P=0.017）。结论　BRVO继发黄斑水肿患者视网膜血流密度等参数存在异常，经雷珠单抗治疗后部分参数得到改善。
Abstract:
Objective　To investigate the effect of ranibizumab on the changes of the density of deep and superficial retinal blood flow in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods　Sixty-two patients (62 eyes) with ME secondary to BRVO admitted to the Ophthalmology Department of Luoyang Third People’s Hospital from July 2019 to July 2020 were selected as the case group, and 36 normal subjects (36 eyes) matched with age and gender were selected as the control group during the same period. Flow density of superficial vascular complex (SVC) in the macular retina, flow density of deep vascular complex (DVC), the area and perimeter of foveal avascular zone (FAZ), asymmetry index (AI) and vessel density within a 300 μm wide region of the FAZ (FD-300) were measured using the scanning mode of OCT angiography (OCTA). Patients in the case group received intravitreal ranibizumab injection for 3 months (1 injection per month) and were followed up for 6 months after treatment. SVD, DVD, FAZ, AI, FD-300 and the best corrected visual acuity (BCVA) were observed at 1 month, 3 months and 6 months after treatment. Pearson’s correlation analysis was performed to analyze the correlation between BCVA and SVD, DVD, FAZ, AI, and FD-300 in the case group after 6 months of treatment.Results　Flow density of SVC in the macular retina and parafovea, flow density of DVC in the macular retina and parafovea and FD-300 in the case group before treatment were significantly lower than those of control group (all P<0.05). Flow density of SVC and DVC in the fovea centralis, the area and perimeter of FAZ and AI in the case group before treatment were significantly higher than those of control group (all P<0.05). Compared with pretreatment levels, flow density of SVC and DVC in the fovea centralis was significantly reduced at 1 month, 3 months and 6 months after treatment in the case group (all P<0.05). FAZ area at 3 months and 6 months after treatment in the case group was significantly enlarged compared with pretreatment levels (both P<0.05). FAZ area at 6 months after treatment was significantly larger than that at 1 month after treatment in the case group (P<0.05). In the case group, AI at 1 month, 3 months and 6 months after treatment was significantly reduced than those of pretreatment levels (all P<0.05). Patients in the case group had a gradually decreased BCVA (logMAR) with the prolongation of treatment, which was statistically significant in the comparison of that measured in the two time points (P<0.05). Pearson’s correlation test showed that BCVA at 6 months after treatment in the case group was positively correlated with flow density of SVC in the fovea (r=0.341, P=0.013), flow density of DVC in the fovea (r=0.339, P=0.015) and AI (r=0.308, P=0.042). BCVA was negatively correlated with FAZ area (r=-0.337, P=0.017).Conclusion　Patients with ME secondary to BRVO have abnormal retinal blood flow density and other parameters, some of which can be improved by ranibizumab mediation.

参考文献/References:

［1］　IP M,HENDRICK A.Retinal vein occlusion review［J］.Asia Pac J Ophthalmol (Phila),2018,7(1):40-45.
［2］　MURAOKA Y,TSUJIKAWA A.Arteriovenous crossing associated with branch retinal vein occlusion［J］.Jpn J Ophthalmol,2019,63(5):353-364.
［3］　赵中芳,杜改萍.玻璃体内注射康柏西普联合激光治疗视网膜静脉阻塞黄斑水肿的长期疗效［J］.中华眼视光学与视觉科学杂志,2020,22(7):518-523.
ZHAO Z F,DU G P.Long-term observation of intravitreal injection of conbercept and photocoagulation in the treatment of macular edema due to retinal vein occlusion［J］.Chin J Optom Ophthalmol Vis Sci,2020,22(7):518-523.
［4］　SANGROONGRUANGSRI S,RATANAPAKORN T,WU O,ANOTHAISINTAWEE T,CHAIKLEDKAEW U.Comparative efficacy of bevacizumab,ranibizumab,and aflibercept for treatment of macular edema secondary to retinal vein occlusion:a systematic review and network meta-analysis［J］.Expert Rev Clin Pharmacol,2018,11(9):903-916.
［5］　BUSCH C,FRASER-BELL S,IGLICKI M,LUPIDI M,COUTURIER A,CHAIKITMONGKOL V,et al.Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant:2-year results［J］.Acta Diabetol,2019,56(12):1341-1350.
［6］　VUJOSEVIC S,TOMA C,VILLANI E,MURACA A,TORTI E,FLORIMBI G,et al.Diabetic macular edema with neuroretinal detachment:OCT and OCT-angiography biomarkers of treatment response to anti-VEGF and steroids［J］.Acta Diabetol,2020,57(3):287-296.
［7］　SCHMIDT-ERFURTH U,GARCIA-ARUMI J,GERENDAS B S,MIDENA E,SIVAPRASAD S,TADAYONI R,et al.Guidelines for the management of retinal vein occlusion by the European society of retina specialists ［J］.Ophthalmologica,2019,242(3):123-162.
［8］　谭亮章,田芳,张红.基于OCTA的近视性屈光参差患者黄斑区血流密度及视网膜厚度分析［J］.眼科新进展,2020,40(3):268-271.
TAN L Z,TIAN F,ZHANG H.Analysis of blood flow density and retinal thickness in macular areas of patients with non-amblyopic myopic anisometropia by OCTA［J］.Rec Adv Ophthalmol,2020,40(3):268-271.
［9］　WANG L Y,LIU C Q,LIU J L,LIN L,YANG K L,MOU Y N,et al.Clinical study of retinal vein occlusion papillary area with quantified OCTA［J］.Int Eye Sci,2020,20(12):2163-2166.
［10］　HOUBEN I,DE Z J,DEGHISLAGE C,FROST N A,NIJS I,VAN CALSTER J.Efficacy of multiple dexamethasone intravitreal implants for refractory retinal vein occlusion-related macular edema and effect of prior vitrectomy［J］.J Ocul Pharmacol Ther,2018,34(10):710-719.
［11］　SAKANISHI Y,YASUDA K,MORITA S,MASHIMO K,TAMAKI K,SAKUMA T,et al.Twenty-four-month results of intravitreal aflibercept for macular edema due to branch retinal vein occlusion［J］.Jpn J Ophthalmol,2021,65(1):63-68.
［12］　LI K J,YU X B,DAI H.The alterations of microvascular structure in branch retinal vein occlusion eyes before and after anti-vascular endothelial growth factor drug therapy［J］.Chin J Ocul Fund Dis,2019,35(1):25-30.
［13］　WERNER J U,BHM F,LANG G,DREYHAUPT J,LANG G K,ENDERS C.Comparison of foveal avascular zone between optical coherence tomography angiography and fluorescein angiography in patients with retinal vein occlusion［J］.PLoS One,2019,14(6):e0217849.
［14］　ADHI M,FILHO M,LOUZADA R N,KUEHLEWEIN L,DE CARLO T E,BAUMAL C R,et al.Retinal capillary network and foveal avascular zone in eyes with vein occlusion and fellow eyes analyzed with optical coherence tomography angiography［J］.Invest Ophthalmol Vis Sci,2016,57(9):486-494.
［15］　RAO J,WU N,QU X,HU Y,WU Y,CHENG Y,et al.The role of serum inflammation-based factors in anti-vascular endothelial growth factor treatment for macular edema secondary to retinal vein occlusion and its subtypes［J］.Ophthalmic Res,2021,64(2):237-245.
［16］　GERDING H.Results of a Meta-analysis on intravitreal anti-VEGF treatment of macular oedema secondary to branch retinal vein occlusion (BRVO)［J］.Klin Monbl Augenheilkd,2017,234(4):551-555.
［17］　VADER M,SCHAUWVLIEGHE A,VERBRAAK F D,DIJKMAN G,HOOYMANS J,LOS L I,et al.Comparing the efficacy of bevacizumab and ranibizumab in patients with retinal vein occlusion:the bevacizumab to ranibizumab in retinal vein occlusions (BRVO) study,a randomized trial［J］.Ophthalmol Retina,2020,4(6):576-587.
［18］　MORIKAWA S,OKAMOTO F,SUGIURA Y,MURAKAMI T,HIRAOKA T,OSHIKA T.Stereopsis after intravitreal ranibizumab injections for branch retinal vein occlusion［J］.Ophthalmol Retina,2019,3(9):777-783.
［19］　WANG J,LI Y,FANG S F,WANG H.Efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion［J］.BMC Ophthalmol,2020,20(1):274.
［20］　PEARCE I,CLEMENS A,BRENT M H,LU L,GALLEGO-PINAZO R,MINNELLA A M,et al.Real-world outcomes with ranibizumab in branch retinal vein occlusion:the prospective,global,LUMINOUS study［J］.PLoS One,2020,15(6):e0234739.
［21］　WU G N,ZHANG X T,HE G H,DONG M,GAO X,WANG M,et al.Changes of retinal microvasculature and visual acuity prognostic of aflibercept treatment in macular edema secondary to retinal vein occlusion［J］.Chin J Ocul Fund Dis,2021,37(4):290-297.
［22］　LEE K H,KANG E C,KOH H J.Angiographically documented macular ischemia after single bevacizumab for macular edema secondary to central retinal vein occlusion［J］.Yonsei Med J,2017,58(3):676-678.
［23］　许畅,黎智.雷珠单抗对视网膜中央静脉阻塞继发黄斑水肿患者黄斑区视网膜血流参数的影响［J］.安徽医药,2018,22(12):2410-2414.
XU C,LI Z.Effect of ranibizumab intravitreal injection on blood flow in eyes with macular edema secondary to central retinal vein occlusion［J］.Anhui Med Pharm J,2018,22(12):2410-2414.
［24］　SUZUKI N,HIRANO Y,TOMIYASU T,ESAKI Y,UEMURA A,YASUKAWA T,et al.Retinal hemodynamics seen on optical coherence tomography angiography before and after treatment of retinal vein occlusion［J］.Invest Ophthalmol Vis Sci,2016,57(13):5681-5687.

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更新日期/Last Update: 2021-09-05