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雷珠单抗玻璃体内注射治疗视网膜静脉阻塞继发黄斑水肿不同OCT分型的临床观察
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| 篇名： | 雷珠单抗玻璃体内注射治疗视网膜静脉阻塞继发黄斑水肿不同OCT分型的临床观察 |
| TITLE： | Clinical observation of intravitreal injection of ranibizumab in the treatment of macular edema with different OCT subtypes of retinal vein obstruction |
| 摘要： | 目的 探索雷珠单抗玻璃体内注射治疗视网膜静脉阻塞（RVO）继发黄斑水肿（ME）不同光学相干断层扫描（OCT）分型的疗效及影响因素。方法回顾性选取2021年1月1日至2024年1月1日天津市眼科医院眼外伤科收治的RVO继发ME患者150例为研究对象。按照患者在OCT下呈现的结果分为弥漫性视网膜增厚型（DRT）组（48例）、囊样黄斑水肿型（CME）组（83例）及浆液性视网膜脱离型（SRD）组（19例）。比较3组患者治疗前及治疗后1、3、6个月的最佳矫正视力（BCVA）、黄斑中心凹处视网膜厚度（CMT），并通过CMT及治疗前后的荧光素眼底血管造影（FFA）数据等比较3组患者的临床疗效；比较3组患者治疗期间的不良反应发生情况以及追加注射雷珠单抗的次数。以治疗后6个月的临床疗效“无效”为因变量，以患者的基线资料为自变量，采用多因素Logistic回归分析影响雷珠单抗临床疗效的危险因素。结果CME组和SRD组患者的视网膜静脉分支阻塞比例明显高于DRT组（P＜0.05），DRT组患者的视网膜中央静脉阻塞（CRVO）比例明显高于CME组和SRD组（P＜0.05）；SRD组患者出现缺血的比例明显高于CME组和DRT组（P＜0.05），而CME组出现缺血的比例明显高于DRT组（P＜0.05）。治疗前，3组患者BCVA和CMT的差异均无统计学意义（P＞0.05）；治疗后，3组患者的BCVA和CMT均较治疗前显著降低（P＜0.05），不同治疗时间点上均表现为CME组和SRD组患者在BCVA和CMT上明显高于DRT组患者（P＜0.05）。治疗后6个月，3组患者的临床疗效差异具有统计学意义（P＜0.05），表现为SRD组患者的无应答比例明显高于DRT组和CME组（P＜0.05）。CME组和SRD组患者的雷珠单抗追加注射次数明显多于DRT组（P＜0.05）。3组患者不良反应发生率的差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，CRVO和缺血型是影响3组患者雷珠单抗临床疗效的共同危险因素；病程较长是影响DRT组患者雷珠单抗临床疗效的独立危险因素。结论雷珠单抗治疗RVO继发ME不同OCT分型的疗效存在差异，其中DRT患者的视力改善最佳，SRD患者的无应答比例最高，CME与SRD患者需要更频繁地追加雷珠单抗注射次数。CRVO和缺血型是RVO继发ME各分型预后不良的共同危险因素，临床上应结合OCT分型及危险因素制定个体化治疗及随访策略。 |
| ABSTRACT： | OBJECTIVE To explore the efficacy and influencing factors of intravitreal injection of ranibizumab in the treatment of macular edema （ME） secondary to retinal vein obstruction （RVO） with different optical coherence tomography （OCT） subtypes. METHODS A retrospective study was conducted on 150 patients with ME secondary to RVO treated at Dept. of Ocular Trauma of Tianjin Eye Hospital between January 1， 2021 and January 1， 2024. According to OCT findings， patients were classified into the diffuse retinal thickening （DRT） group （48 cases）， cystoid macular edema （CME） group （83 cases）， and serous retinal detachment （SRD） group （19 cases）. The best corrected visual acuity （BCVA） and central macular thickness （CMT） were compared before and at 1， 3 and 6 months after treatment. Clinical efficacies of 3 groups were compared based on CMT and fluorescein fundus angiography （FFA） findings before and after treatment. Adverse events and the number of additional injections of ranibizumab during treatment were compared among 3 groups. Using “ineffectiveness” in clinical outcomes at 6 months post- treatment as the dependent variable and patients’ baseline data as the independent variables， a multivariate Logistic regression analysis was conducted to identify risk factors influencing the clinical efficacy of ranibizumab. RESULTS The proportion of branch RVO was significantly higher in the CME and SRD groups than in the DRT group （P＜0.05）， while central RVO （CRVO） was more frequent in the DRT group than in the CME and SRD groups （P＜0.05）. The proportion of patients with ischemia was highest in the SRD group， followed by the CME and DRT groups （P＜0.05）， while the proportion of patients with ischemia in the CME group was significantly higher than that in the DRT group （P＜0.05）. Before treatment， the BCVA and CMT showed no significant differences among the 3 groups （P＞0.05）. After treatment， BCVA and CMT in all 3 groups were significantly reduced compared to those before treatment （P＜0.05）. At different treatment time points， patients in the CME group and SRD group consistently showed significantly higher BCVA and CMT values compared to those in the DRT group （P＜0.05）. Six months after treatment， the differences in clinical efficacy among the 3 groups were statistically significant （P＜0.05）， with the proportion of non-responders in the SRD group being significantly higher than that in the DRT group and the CME group （P＜0.05）. The number of additional injections of ranibizumab in patients from the CME group and the SRD group was significantly more than that in the DRT group （P＜0.05）. The incidence of adverse reactions did not differ significantly among 3 groups （P＞0.05）. Multivariate Logistic regression revealed that CRVO and ischemic type were common risk factors affecting the clinical efficacy of ranibizumab in all 3 groups， while longer disease duration was an independent risk factor for the clinical efficacy of ranibizumab in patients from the DRT group. CONCLUSIONS The therapeutic efficacy of ranibizumab varies among different OCT phenotypes of ME secondary to RVO. DRT patients achieve the best visual improvement， SRD patients have the highest non-response rate， and CME/SRD patients require more additional injections of ranibizumab. CRVO and ischemia are shared adverse prognostic factors for poor prognosis in various subtypes of ME secondary to RVO. Individualized treatment and follow-up strategies should be developed based on OCT patterns and risk factors. |
| 期刊： | 2025年第36卷第21期 |
| 作者： | 陈颖；薛超；陈甲兴 |
| AUTHORS： | CHEN Ying，XUE Chao，CHEN Jiaxing |
| 关键字： | 雷珠单抗；视网膜静脉阻塞；黄斑水肿；光学相干断层扫描；弥漫性视网膜增厚型；囊样黄斑水肿型；浆液性视网膜脱离 |
| KEYWORDS： | ranibizumab； retinal vein obstruction； macular edema； optical coherence tomography； diffuse retinal thickening； |
| 阅读数： | 4 次 |
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