[1]白小芳,赵芃芃,秦梅,等.雷珠单抗联合Ozurdex治疗视网膜分支静脉阻塞继发黄斑水肿的疗效观察[J].眼科新进展,2022,42(5):394-398.[doi:10.13389/j.cnki.rao.2022.0080]
　BAI Xiaofang,ZHAO Pengpeng,QIN Mei,et al.Clinical effect of Ranibizumab combined with Ozurdex in the treatment of macular edema secondary to branch retinal vein occlusion[J].Recent Advances in Ophthalmology,2022,42(5):394-398.[doi:10.13389/j.cnki.rao.2022.0080]
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雷珠单抗联合Ozurdex治疗视网膜分支静脉阻塞继发黄斑水肿的疗效观察/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
42卷
期数:
2022年5期
页码:
394-398
栏目:
应用研究
出版日期:
2022-05-05

文章信息/Info

Title:
Clinical effect of Ranibizumab combined with Ozurdex in the treatment of macular edema secondary to branch retinal vein occlusion
作者:
白小芳; 赵芃芃; 秦梅; 卢凤丽; 张琴; 李思园; 谭丛
233000　安徽省蚌埠市 蚌埠医学院第一附属医院眼科
Author(s):
BAI Xiaofang; ZHAO Pengpeng; QIN Mei; LU Fengli; ZHANG Qin; LI Siyuan; TAN Cong
Department of Ophthalmology，the First Affiliated Hospital of Bengbu Medical College，Bengbu 233000，Anhui Province，China
关键词:
视网膜分支静脉阻塞; 雷珠单抗; Ozurdex; 黄斑水肿
Keywords:
branch retinal vein occlusion;  Ranibizumab;  Ozurdex;  macular edema
分类号:
R774
DOI:
10.13389/j.cnki.rao.2022.0080
文献标志码:
A
摘要:
目的　通过比较地塞米松玻璃体内植入剂（Ozurdex）联合雷珠单抗与雷珠单抗单药或Ozurdex单药治疗视网膜分支静脉阻塞继发黄斑水肿（BRVO-ME）患者的疗效，评价联合用药的有效性和安全性。方法　选择2020年2月至2021年9月就诊于蚌埠医学院第一附属医院眼科的38例（38眼）BRVO-ME患者，分为雷珠单抗组（17例17眼，患者仅进行玻璃体内雷珠单抗注射），Ozurdex组（11例11眼，患者仅进行玻璃体内Ozurdex注射），联合组（10例10眼，患者先进行玻璃体内雷珠单抗注射，2周后再进行玻璃体内Ozurdex注射）。记录3组患者治疗前后最佳矫正视力（BCVA)、黄斑中心凹视网膜厚度（CMT）、眼压、注药次数，并观察术后不良反应情况。结果　与治疗前相比，雷珠单抗组和联合组治疗后1个月、2个月、3个月、4个月、6个月、12个月患者CMT均降低，BCVA均有所提高，差异均有统计学意义( 均为P<0.05）。与治疗前相比，Ozurdex组治疗后1个月、2个月、3个月、6个月、12个月患者CMT均降低，BCVA均有所提高，差异均有统计学意义(均为P<0.05），而治疗后4个月时患者BCVA与治疗前比较差异无统计学意义（P>0.05），CMT与治疗前比较差异有统计学意义（P<0.05）。与雷珠单抗组和联合组相比，Ozurdex组治疗后4个月和12个月患者CMT增加，BCVA降低，差异均有统计学意义（均为P<0.05）。治疗后1个月、2个月、3个月、4个月、6个月、12个月，雷珠单抗组与联合组患者CMT比较差异均无统计学意义（均为P>0.05）。雷珠单抗组、Ozurdex组和联合组患者注射次数分别为（7.94±1.34）次、（2.82±0.75）次和（3.78±1.20）次，雷珠单抗组与Ozurdex组和联合组相比差异均有统计学意义（均为P<0.05），而联合组与Ozurdex组相比差异无统计学意义（P>0.05）。治疗后1个月、2个月、3个月和6个月，Ozurdex组和联合组患者均出现眼压升高（均为P<0.05），其中，治疗后2个月和6个月时患者眼压升高最为显著。 Ozurdex组和联合组分别有2例2眼、1例1眼发生白内障进展，需要进行白内障手术。3组患者术后均未发生眼内炎、玻璃体积血、视网膜脱离等并发症。结论　雷珠单抗单药、Ozurdex单药和联合用药均能有效改善BRVO-ME患者黄斑水肿并提高患者视力，但雷珠单抗单药和联合用药比Ozurdex单药能更好地降低患者CMT并改善视力。同时，与雷珠单抗单药治疗相比，联合用药能减少患者注药次数，降低经济负担，而Ozurdex植入会导致更多类固醇相关副作用，特别是高眼压的发生。
Abstract:
Objective　To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) combined with Ranibizumab, Ranibizumab, and Ozurdex monotherapy in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO-ME). Methods　A total of 38 patients (38 eyes) with BRVO-ME who were admitted to the Department of Ophthalmology of the First Affiliated Hospital of Bengbu Medical College from February 2020 to September 2021 were divided into the Ranibizumab group (17 patients with 17 eyes, intravitreally injected with Ranibizumab), Ozurdex group (11 patients with 11 eyes, intravitreally injected with Ozurdex), and combined group (10 patients with 10 eyes, intravitreally injected with Ranibizumab first and then Ozurdex after 2 weeks). The best corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), times of drug injection, and postoperative adverse reactions were recorded in the three groups before and after treatment. Results　At 1, 2, 3, 4, 6 and 12 months after treatment, CMT decreased and BCVA increased in the Ranibizumab and combined groups compared with the baseline, and the differences were statistically significant (all P<0.05). At 1, 2, 3, 6 and 12 months after treatment, CMT decreased and BCVA increased in the Ozurdex group compared with the baseline, and the differences were statistically significant (all P<0.05), while at 4 months after treatment, there was a significant difference in CMT (P<0.05) but no significant difference in BCVA (P>0.05) compared with the baseline. Compared with the Ranibizumab and combined groups, CMT increased and BCVA decreased in the Ozurdex group at 4 and 12 months after treatment, and the differences were statistically significant (all P<0.05). There was no significant difference in CMT between the Ranibizumab group and the combined group at 1, 2, 3, 4, 6 and 12 months after treatment (all P>0.05). The number of injections in the Ranibizumab group, Ozurdex group, and combined group were 7.94±1.34, 2.82±0.75, and 3.78±1.20, respectively. There was a significant difference between the Ranibizumab and Ozurdex groups, Ranibizumab and combined groups (all P<0.05), but no significant difference between the combined and Ozurdex groups (P>0.05). IOP in the Ozurdex and combined groups increased significantly at 1, 2, 3 and 6 months after treatment (all P<0.05), especially at 2 and 6 months. Cataract progression occurred in 2 eyes in the Ozurdex group and 1 eye in the combined group, requiring cataract surgery. There were no postoperative complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment in the three groups. Conclusion　Ranibizumab, Ozurdex, and combined therapy can effectively improve macular edema and visual acuity in patients with BRVO-ME, but Ranibizumab monotherapy and combined therapy can better reduce CMT and improve visual acuity than Ozurdex monotherapy. Compared with Ranibizumab monotherapy, combined therapy can reduce the frequency of drug injection, thus lowering costs, while Ozurdex monotherapy may lead to more steroid-related side effects, especially high IOP.

参考文献/References:

［1］　LASHAY A,RIAZI-ESFAHANI H,MIRGHORBANI M,YASERI M.Intravitreal medications for retinal vein occlusion:systematic review and meta-analysis［J］.Ophthalmic Vis Res,2019,14(3):336-366.
［2］　EHLERS J P,FEKRAT S.Retinal vein occlusion:beyond the acute event［J］.Surv Ophthalmol,2011,56(4):281-299.
［3］　HEIER J S,CAMPOCHIARO P A,YAU L,LI Z,SAROJ N,RUBIO R G,et al.Ranibizumab for macular edema due to retinal vein occlusions:long-term follow-up in the HORIZON trial［J］.Ophthalmology,2012,119(4):802-809.
［4］　宋爽,喻晓兵,戴虹.玻璃体腔注射雷珠单抗联合曲安奈德或激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿疗效观察［J］.中华眼底病杂志,2015,31(1):18-21.
SONG S,YU X B,DAI H.Vitreous injection of ranibizumab combined with triamcinolone acetonide or laser photocoagulation in the treatment of macular edema secondary to branch retinal vein occlusion［J］.Chin J Ocul Fundus Dis,2015,31(1):18-21.
［5］　GARAY-ARAMBURU G,GOMEZ-MORENO A.A 5-year follow-up study of the treatment of macular edema due to retinal vein occlusion using dexamethasone intravitreal implants［J］.Ocul Pharmacol Ther,2018,34(6):436-441.
［6］　HOERAUF H,FELTGEN N,WEISS C,PAULUS E M,SCHMITZ-VALCKENBERG S,PIELEN A,et al.Clinical efficacy and safety of ranibizumab versus dexamethasone for central retinal vein occlusion (COMRADE C):a European label study［J］.Am J Ophthalmol,2016,169:258-267.
［7］　YOON Y H,KIM J W,LEE J Y,KIM I T,KANG S W,YU H G,et al.Dexamethasone intravitreal implant for early treatment and retreatment of macular edema related to branch retinal vein occlusion:the multicenter COBALT study［J］.Ophthalmologica,2018;240(2):81-89.
［8］　HALLER J A,BANDELLO F,BELFORT R J,BLUMENKRANZ M S,GILLIES M,HEIER J,et al.Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results［J］.Ophthalmology,2011,118(12):2453-2460.
［9］　LI X,WANG N,LIANG X,XU G,LI X Y,JIAO J,et al.Safety and efficacy of dexamethasone intravitreal implant for treatment of macular edema secondary to retinal vein occlusion in Chinese patients:randomized,sham-controlled,multicenter study［J］.Graefes Arch Clin Exp Ophthalmol,2018,256(1):59-69.
［10］　CAPONE A J,SINGER M A,DODWELL D G,DREYER R F,OH K T,ROTH D B,et al.Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study) ［J］.Retina,2014,34(2):342-351.
［11］　MATONTI F,MEYER F,GUIGOU S,BARTHELEMY T,DUMAS S,GOBERT F,et al.Ozurdex in the management of the macular edema following retinal vein occlusion in clinical practice［J］.Acta Ophthalmol,2013,91(7):e584-e586.
［12］　MATONTI F,POMMIER S,MRYER F,HAJJAR C,MERITE P Y,PARRAT E,et al.Long-term efficacy and safety of intravitreal dexamethasone implant for the treatment of diabetic macular edema［J］.Eur J Ophthalmol,2016,26(5):454-459.
［13］　GIUFFRE C,CICINLLI M V,MARCHESE A,COPPOLA M,PARODI M B,BANDELLO F.Simultaneous intravitreal dexamethasone and aflibercept for refractory macular edema secondary to retinal vein occlusion［J］.Graefes Arch Clin Exp Ophthalmol,2020,258(4):787-793.
［14］　SINGER M A,JANSEN M E,TYLER L,WOODS P,ANSARI F,JAIN U,et al.Long-term results of combination therapy using anti-VEGF agents and dexamethasone intravitreal implant for retinal vein occlusion:an investigational case series［J］.Clin Ophthalmol,2017,11:31-38.
［15］　COSCAS G,AUGUSTIN A,BANDELLO F,DE SMET M D,LANZETTA P,STAURENGHI G,et al.Retreatment with Ozurdex for macular edema secondary to retinal vein occlusion［J］.Eur J Ophthalmol,2014,24(1):1-9.
［16］　BANDELLO F,AUGUSTIN A,TUFAIL A,LEABACK R.A 12-month,multicenter,parallel group comparison of dexamethasone intravitreal implant versus ranibizumab in branch retinal vein occlusion［J］.Eur J Ophthalmol,2018,28(6):697-705.

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更新日期/Last Update: 2022-05-17