地塞米松玻璃体植入剂治疗不同OCT分型RVO继发ME的疗效对比

Comparison of the Efficacy of Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Secondary to RVO with Different OCT Types

摘要: 目的：观察地塞米松玻璃体植入剂(Ozurdex)对视网膜静脉阻塞(retinal vein occlusion, RVO)继发黄斑水肿(macular edema, ME)的疗效，对比在不同OCT分型中的疗效并探究RVO患者预后影响因素。方法：回顾性研究。选取2018-6/2019-12于我院诊断为RVO继发ME的31例31眼作为研究对象。根据黄斑中心凹厚度(central macular thickness, CMT)分为：CMT ≤ 600 um组(15眼)，CMT > 600 um组(16眼)；根据是否存在浆液性视网膜脱离(serous retinal detachment, SRD)分为：SRD组(13眼)，非SRD组(18眼)。31眼均行玻璃体腔内Ozurdex植入。观察并对比各组治疗前后各时间点(植入前、植入后14 d、1 mo、2 mo、3 mo、4 mo、5 mo、6 mo)的最佳矫正视力(best corrected visual acuity, BCVA)、CMT、眼压、复发率、不良反应。结果：与植入前比较，植入后14 d至6 mo患者的BCVA提高、CMT下降(P < 0.001)。CMT ≤ 600 um组BCVA优于CMT > 600 um组(P < 0.05)。植入前、植入后14 d、5 mo及6 mo CMT ≤ 600 um组CMT低于CMT > 600 um组(P < 0.05)。植入后4 mo、5 mo及6 mo，非SRD组BCVA优于SRD组、CMT小于SRD组(P < 0.05)。与植入前进行比较，植入后14 d至4 mo患者眼压升高(P < 0.05)。CMT > 600 um及合并SRD的患者复发率高于CMT ≤ 600 um及不合并SRD者(P < 0.05)。结论：Ozurdex可以在6月内提高RVO继发ME患者BCVA，降低CMT。部分患者ME会复发，CMT > 600 um及合并SRD的患者更容易复发。初始ME的轻重以及有无SRD是RVO患者的预后影响因素。

Abstract: Aim: To observe the efficacy of intravitreal dexamethasone implant (Ozurdex) for the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO), compare the efficacy in different OCT types and explore the prognostic factors of RVO patients. Methods: Retrospective Study. A total of 31 cases of ME secondary to RVO diagnosed in our hospital from June 2018 to December 2019 were selected as the research subjects. According to the central macular thickness (CMT), they were divided into two groups: the CMT ≤ 600 um group (15 eyes) and the CMT > 600 um group (16 eyes); according to the existence of serous retinal detachment (SRD), the patients were divided into the SRD group (13 eyes) and the non-SRD group (18 eyes). All patients were intravitreally injected with Ozurdex. The best corrected visual acuity (BCVA), CMT, intraocular pressure, recurrence rate and adverse reactions were observed and compared at each time point (before implantation, 14 d, 1, 2, 3, 4, 5 and 6 mo after implantation). Results: Compared with pre-injection, BCVA was increased and CMT was decreased from 14 d to 6 mo after injection (P < 0.001). BCVA in the CMT ≤ 600 um group was better than that in the CMT > 600 um group (P < 0.05). Before implantation, 14 d, 5 mo and 6 mo after implantation, CMT of the CMT ≤ 600 um group was lower than that of the CMT > 600 um group (P < 0.05). At 4 mo, 5 mo and 6 mo after implantation, BCVA in the non-SRD group was greater than that in the SRD group, while CMT was lower than that in the combined SRD group (P < 0.05). Compared with pre-implantation, intraocular pressure increased from 14 d to 4 mo after implantation (P < 0.05). RVO patients with CMT > 600 um and SRD were more prone to relapse (P < 0.05). Conclusion: Ozurdex increased BCVA and decreased CMT in patients with ME secondary to RVO within 6 months. However, some patients with ME will relapse. Patients with CMT > 600 um and SRD were more likely to relapse. The severity of the baseline ME and the presence of SRD are prognostic factors in patients with RVO.