临床实际中应用抗VEGF药物治疗视网膜静脉阻塞性黄斑水肿的现状及疗效观察

The Actual State of the Application of Anti-VEGF Drugs in the Treatment of Macular Edema of Retinal Vein Occlusion

摘要: 目的：分析临床实际中玻璃体腔注射抗新生血管生成因子类药物治疗视网膜静脉阻塞性黄斑水肿的实际状况，并进一步分析其可能原因，以便为临床治疗决策提供进一步的指导。方法：回顾性非随机临床病例研究，共收集研究期间，在我院所有行玻璃体腔注射抗血管内皮生长因子(anti-vascular endothelial growth factor, anti-VEGF)类药物治疗的视网膜静脉阻塞(retinal vein occlusion, RVO)患者61例(62只眼) (去除失访5人)纳入研究，记录患者的年龄、性别、全身病史，注射药物的种类，注射的次数，以及视力情况、黄斑中心凹的厚度改变等；以分析临床治疗中的实际情况。结果：共有男性30例(31只眼)、女性31例(31只眼)纳入研究，平均年龄(58.75 ± 19.30)岁，其中BRVO50例(50只眼)，CRVO11例(12只眼)；合并有糖尿病等全身疾病的患者比例达56.7%；从患病到就诊的平均时间从6天到2年不等；雷珠单抗注射液与康柏西普注射液的使用频次比为3比1；玻璃体腔注射一次的占45.9%，注射2次及3次的分别占18%及23%，而注射3次以上的为13.1%；黄斑中心凹的平均厚度由治疗前的477.35 ± 202.21微米，降低到随访结束时的259.24 ± 99.52微米，注射治疗后黄斑中心凹的厚度平均减少了218.12微米，差异具有统计学意义。视力由治疗前的平均4.23 ± 0.52提高到随访结束时的平均4.60 ± 0.43，平均提高3行，差异具有统计学意义。除2例在研究期间发生心梗、脑梗外，无新发的眼部及其他全身的并发症。终止治疗原因中，53%由于临床治愈，25%因经济原因放弃治疗，其他原因包括全身心脑血管病发作，高龄等。结论：视网膜静脉阻塞是常见 的眼底疾病，分支静脉阻塞比中央静脉阻塞发病率更高，合并全身疾病的比例高；抗VEGF类药物对视网膜静脉阻塞性黄斑水肿的治疗是有效的，注射治疗后黄斑中心凹的厚度平均减少了218.12微米，视力平均提高3行；注射治疗方案不一，非病情原因影响治疗的最主要原因是经济原因。

Abstract: Objective: To study the actual state of anti-VEGF drugs in the treatment of macular edema of retinal vein occlusion. Further analyses were also made to provide further guidance for clinical decision. Methods: This is a retrospective nonrandomized clinical case study. A total collection of 62 eyes of 61 patients with macula edema of retinal vein occlusion had been involved in the study (5 patients were excluded to losing the follow-up). The age, the gender, the general disease history, the intra-vitreal injection times and the classes of anti-VEGF drugs were observed. The best corrected visual acuity (BCVA) and the thickness of macular fovea were also observed. Results: A total of 30 males (31 eyes) and 31 females (31 eyes) were included in the study, with an average age (58.75 ± 19.30), of which BRVO50 (50 eyes), CRVO11 (12 eyes); the proportion of patients with systemic diseases such as diabetes was 56.7%. The average time from illness to visit ranged from 6 days to 2 years; and the frequency of using Ranibizumab is three times to that of using Conpercept. The patients with only one intra-vitreal injection were occupied 45.9 percent. Those with two or three injections were occupied 18 and 23 percent. And those with more than three times injections were occupied 13.1 percent. The average of the BCVA was 4.23 ± 0.52 before the treatment, and it was 4.60 ± 0.43 at the end of the follow-up. All patients gained increased BCVA by three lines through operation. There are statistical differences between the BCVA of postoperation and preoperation. The average thickness of the macular fovea was reduced from 477.35 ± 202.21 micrometers to 259.24 ± 99.52 micrometers. And the thickness of macular fovea was decreased by 218.12 micrometer through operation averagely. And there are statistical differences between the thickness of macular fovea of postoperation and preoperation also. In addition to 2 cases of myo-cardial infarction and cerebral infarction during the study, there were no new ophthalmic and other systemic complications. The reason for the termination of the treatment is 53 percent due to clinical recover, 25 percent for economic reasons, and other causes including the onset of cardiovascular disease, and the eldest age, etc. Conclusion: Retinal vein occlusion is a common fundus disease, with a higher incidence of branch vein occlusion than central vein occlusion and a high proportion of systemic diseases. The application of intra-vitreal anti-VEGF injection for the treatment of macula edema of retinal vein occlusion was effective. All patients gained increased BCVA by three lines through operation. And the thickness of macular fovea was decreased by 218.12 micrometer through operation averagely. The treatment protocols were not all the same. The main reason for the unwished termination of treatment was economy.