玻璃体腔注射康柏西普联合曲安奈德与单用康柏西普治疗青年CRVO的临床疗效比较

Comparison of Clinical Efficacy of Intravitreal Injection of Conbercept Combined with Triamcinolone Acetonide and Conbercept Alone on the Treatment of CRVO in Young Adults

摘要: 背景：视网膜中央静脉阻塞(central retinal vein occlusion CRVO)继发黄斑水肿治疗的理论基础是降低VEGF (vascular endothelial growth factor)的作用，中青年CRVO的发病机制与炎症密切相关，康柏西普联合曲安奈德(triamcinolone acetonide, TA)在青年CRVO治疗方面的研究较少。目的：比较康柏西普(Conbercept)联合曲安奈与单用康柏西普治疗青年CRVO的临床疗效及安全性。方法：采用回顾性研究，选择2015.06~2019.04于淄博市中心医院眼科行康柏西普联合1 mg TA玻璃体腔注射治疗的20例(20眼)青年CRVO患者，作为观察组，同时间行0.5 mg (0.05 ml)康柏西普玻璃体腔注射治疗的20例(20眼)青年CRVO患者作为对照组。观察两组的视力、眼压、裂隙灯、眼底检查、眼底荧光血管造影和光学相干断层扫描等指标变化情况及有无全身不良反应，并比较治疗前及治疗后1个月、3个月、6个月的最佳矫正视力(best-correct visual acuity, BCVA) EDTRS字母数、黄斑中心视网膜厚度(central retina thickness, CRT)、眼压及两组的注射次数。结果：两组人口基线特征相比无差异(P > 0.05)，观察组治疗前BCVA为65.35 ± 6.11，治疗后1、3、6个月的BCVA分别为75.40 ± 4.47、76.05 ± 3.71、75.85 ± 3.88，较治疗前均有提高；对照组治疗前BCVA为67.30 ± 5.99，治疗后1、3、6个月的BCVA分别为73.00 ± 3.84、73.00 ± 5.53、76.40 ± 3.25，较治疗前均有提高，观察组治疗3个月BCVA高于对照组(P < 0.05)，治疗6个月两组BCVA组间比较无差异(P > 0.05)，对照组较治疗前提高>10个字母8例，提高5~10个字母12例，观察组较治疗前提高>10个字母11例，提高5~10个字母7例，提高<5个字母2例。观察组治疗前基线CRT为(518.85 ± 30.67) μm，治疗后1、3、6个月的CRT分别为(271.65 ± 75.31)、(260.20 ± 68.15)、(271.35 ± 80.82) μm，均低于治疗前；对照组治疗前CRT为(519.45 ± 39.54) μm，治疗后1、3、6个月的CRT分别为(312.05 ± 93.55)、(317.35 ± 97.27)、(276.30 ± 73.09) μm，均低于治疗前，观察组治疗3个月CRT低于对照组(P < 0.05)。对照组治疗前眼压为(13.90 ± 2.75) mmHg，治疗后1个月、3个月、6个月眼压为(15.05 ± 2.31)、(15.25 ± 2.51)、(15.95 ± 2.42) mmHg，与治疗前相比，差异无统计学意义(P > 0.05)，观察组治疗前眼压为(14.65 ± 1.93) mmHg，治疗后1个月、3个月、6个月眼压为(15.50 ± 2.01)、(15.10 ± 2.73)、(15.05 ± 2.70) mmHg，与治疗前相比，差异无统计学意义(P > 0.05)，观察组与对照组治疗后各时间点眼压相比，差异无统计学意义。对照组注射2~4 (3.00 ± 0.65)次，观察组注射1~2 (1.25 ± 0.44)次，两组有统计学差异(P < 0.05)。两组均未发生青光眼、白内障、眼内炎等眼部并发症及全身不良反应。结论：康柏西普联合曲安奈德与单用康柏西普玻璃体腔注射均能减轻青年型CRVO患者的黄斑水肿，提高矫正视力。与单用康柏西普相比，康柏西普联合曲安奈德能减少注射次数。

Abstract: Background: The theoretical basis for treating macular edema secondary to central retinal vein occlusion is to reduce the effect of vascular endothelial growth factor. The pathogenesis of central retinal vein occlusion in young and middle-aged people is closely related to inflammation. The research of the treatment of CRVO in young adults with intravitreal injection of conbercept combined with triamcinolone acetonide is rather little. Objective: To compare the clinical efficacy and safety of intravitreal injection of conbercept combined with triamcinolone acetonide and conbercept alone in the treatment of CRVO in young adults. Methods: A retrospective study was designed. Twenty cases (20 eyes) of young patients with central retinal vein occlusion who received intravitreal injection of conbercept combined with 1 mg triamcinolone acetonide in Ophthalmology Department of Zibo Central Hospital from June 2015 to April 2019 were selected as the observation group, and 20 cases (20 eyes) of young patients with central retinal vein occlusion who received intravitreal injection of 0.5 mg (0.05 ml) conbercep at the same time were selected as the control group. We will observe the changes of visual acuity, intraocular pressure, slit lamp, fundus examination, fundus fluorescence angiography and optical coherence tomography and the presence of systemic adverse reactions in the two groups and compare the best corrected visual acuity, central retina thickness, intraocular pressure and the number of injections in both groups before and after treatment 1 month, 3 months, 6 months. Results: There was no difference in baseline population characteristics between the two groups (P > 0.05). The best corrected visual acuity of the observation group before treatment was 65.35 ± 6.11, and the best corrected visual acuity at 1, 3 and 6 months after treatment was (75.40 ± 4.47), (76.05 ± 3.71), (75.85 ± 3.88), which were all higher than those before treatment. The best corrected visual acuity of the control group before treatment was (67.30 ± 5.99), and the best corrected visual acuity at 1, 3 and 6 months after treatment was (73.00 ± 3.84), (73.00 ± 5.53), (76.40 ± 3.25), which were all higher than those before treatment. The best corrected visual acuity in the observation group was higher than that in the control group when the treatment time is three months (P < 0.05). There was no difference in the best corrected visual acuity between the two groups when the treatment time is six months (P > 0.05). Compared with before treatment, 8 patients in the control group increased by more than 10 letters, and 12 patients increased by 5 - 10 letters and in the observation group, 11 patients improved by more than 10 letters, 7 patients improved by 5 - 10 letters, and 2 patients improved by less than 5 letters. The central retina thickness of the observation group before treatment was (518.85 ± 30.67) μm, and the central retina thickness of the observation group at 1, 3 and 6 months after treatment was (271.65 ± 75.31), (260.20 ± 68.15), (271.35 ± 80.82) μm, which were all lower than those before treatment. The central retina thickness of the control group before treatment was (519.45 ± 39.54) μm, and the central retina thickness of the control group at 1, 3 and 6 months after treatment was 312.05 ± 93.55, 317.35 ± 97.27, and 276.30 ± 73.09 μm, which were all lower than those before treatment. The central retina thickness in the observation group was lower than that in the control group when the treatment time is 3 months (P < 0.05). The intraocular pressure of the control group before treatment was (13.90 ± 2.75) mmHg, and the intraocular pressure at 1, 3 and 6 months after treatment was (15.05 ± 2.31), (15.25 ± 2.51), (15.95 ± 2.42) mmHg. Compared with before treatment, the difference was not statistically significant (P > 0.05). The intraocular pressure of the observation group before treatment was (14.65 ± 1.93) mmHg, and the intraocular pressure of the control group at 1, 3 and 6 months after treatment was (15.50 ± 2.01), (15.10 ± 2.73), (15.05 ± 2.70) mmHg. Compared with before treatment, the difference was not statistically significant (P > 0.05). There was no significant difference in intraocular pressure between the two groups after treatment (P > 0.05). The number of injections in the control group was 2 - 4 times (3.00 ± 0.65), and the number of injections in the observation group was 1 - 2 times (1.25 ± 0.44). There was a statistical difference between the two groups (P < 0.05). There is no glaucoma, cataract, endophthalmitis and other ocular complications and systemic adverse reactions occurred in the control group and the observation group. Conclusion: The treatment of intravitreal conbercept with triamcinolone acetonide and conbercept alone all can relieve the macular edema, improve the best corrected visual acuity of central retinal vein occlusion in young adults. Compared with intravitreal conbercept alone, intravitreal conbercept with triamcinolone acetonide can reduce the number of injections.