玻璃体腔内注射康柏西普治疗不同类型视网膜静脉阻塞合并黄斑水肿的疗效观察

doi:10.3877/cma.j.issn.2095-2007.2017.05.005

目的

观察玻璃体腔内注射康柏西普治疗视网膜中央静脉阻塞(CRVO)及视网膜分支静脉阻塞(BRVO)合并黄斑水肿(ME)的临床效果。

方法

选取2014年7月至2017年2月经北京市房山区良乡医院眼科诊断为视网膜静脉阻塞(RVO)合并ME患者27例(27只眼)的临床资料。将全部患者按照静脉阻塞类型分为两组，即CRVO组与BRVO组。CRVO组患者共8例(8只眼)，BRVO组患者共19例(19只眼)。全部患者于玻璃体腔内注射康柏西普，每月1针，连续注射3针。检查并记录两组患者注射前、注射第一针后1周、第二针后1周、第三针后1周及第三针后1个月时患者的黄斑中心凹厚度(CMT)及最佳矫正视力(BCVA)，并对结果进行统计学分析。采用重复测量资料的方差分析对治疗前后两组内不同时间点的BCVA及CMT数据进行统计分析，当差异有统计学意义时，进一步采用配对t检验进行两两比较。

结果

CRVO组患者治疗前的CMT值为(768.50±344.93)μm，注射第三针后1个月时为(504.13±287.91)μm，二者比较差异有统计学意义(t＝5.079，P<0.05)。治疗后各时间点的CMT值与治疗前比较均明显降低，差异有统计学意义(t＝2.458，5.366，3.614，5.079；P<0.05)。BRVO组患者治疗前的CMT值为(650.47±317.67)μm，注射第三针后1个月时为(332.11±187.58)μm，二者比较差异有统计学意义(t＝7.650，P<0.05)。治疗后各时间点的CMT值与治疗前比较均明显降低，差异有统计学意义(t＝3.967，5.459，6.422，7.650；P<0.05)。CRVO组患者治疗前的BCVA为0.95±0.31，注射第三针后1个月时为0.76±0.35，二者比较差异有统计学意义(t＝3.416，P<0.05)。第一针后1周时的BCVA与治疗前比较，差异无统计学意义(t＝1.528，P>0.05)。此后各时间点的BCVA值与治疗前比较均显著改善，差异有统计学意义(t＝2.376，2.553，3.416；P<0.05)。BRVO组患者治疗前的BCVA为0.68±0.34，注射第三针后1个月时为0.40±0.18，二者比较差异有统计学意义(t＝5.931，P<0.05)。治疗后各时间点的BCVA值与治疗前比较均显著改善，差异有统计学意义(t＝2.163，3.139，5.224，5.931；P<0.05)。两组患者治疗前BCVA值的差异无统计学意义(F＝3.57，P>0.05)。将两组患者治疗后各时间点的BCVA改善情况进行比较，BRVO组明显优于CRVO组，且随注药次数的增加，差异越发明显，注射第三针后1个月时两组间的BCVA差异最为显著(F＝7.20，8.28，9.01，12.68；P<0.05)。

结论

玻璃体腔注射康柏西普对于CRVO及BRVO合并ME的治疗安全有效。且BRVO患者的治疗效果较CRVO患者的治疗效果更显著。

关键词: 玻璃体腔内注射, 康柏西普, 视网膜静脉阻塞, 黄斑水肿

Objective

To observe the clinical efficacy of intravitreal injection of Compaq in the treatment of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) complicated with macular edema (ME).

Methods

The clinical data of 27 patients (27 eyes) with macular edema secondary to retinal vein occlusion (RVO) diagnosed by ophthalmology in Liangxiang Hospital of Beijing Fangshan District from July 2014 to February 2017 were. The patients were divided into two groups according to the types of venous obstruction, that is, group CRVO (group A) and group BRVO (group B). There were 8 cases (8 eyes) in group A, and 19 cases (19 eyes) in group B. All patients were treated with intravitreal injection of Compaq, followed by a continuous infusion of 3 injections, with 1 injections per month. The CMT and BCVA of the two groups of patients were examined before and after the first injection, 1 week after the first injection, 1 week after the second injection, 1 week after the third injection, and 1 month after the third injection, and the results were statistically analyzed. The variance of repeated measurement data were analyzed before and after treatment in two groups at different time points in the BCVA and CMT data, the difference was statistically significant, further paired t test was used for comparison of two groups.

Results

Before group A treatment, the CMT value was (768.50±344.93)μm, and (504.13±287.91) μm 1 month after the third injection, the difference was statistically significant (t=5.079, P<0.05). The CMT values at each time point after treatment were significantly lower than those before treatment (t=2.458, 5.366, 3.614, 5.079; P<0.05). The CMT value before treatment in group B was (650.47±317.67)μm, and (332.11±187.58)μm 1 month after the third injection, the difference was statistically significant (t=7.650, P<0.05). The CMT values at each time point after treatment were significantly lower than those before treatment (t=3.967, 5.459, 6.422, 7.650; P< 0.05). The BCVA in group A was 0.95±0.31 before treatment and 0.76±0.35 1 month after the third injection. The difference was statistically significant (t=3.416, P<0.05). There was no statistical difference of BCVA between before and 1 week after the first injection (t=1.528, P>0.05). At each time point, BCVA values were significantly improved compared with those before treatment (t=2.376, 2.553, 3.416; P<0.05). The BCVA in the B group was 0.68±0.34 before treatment and 0.40±0.18 1 month after the third injection. The difference was statistically significant (t=5.931, P<0.05); At each time point after treatment, BCVA value was significantly improved compared with before treatment (t=2.163, 3.139, 5.224, 5.931; P<0.05). There was no significant difference in BCVA value between the two groups before treatment (F=3.57, P>0.05). The two groups of patients at each time point after BCVA were observed and compared, B group was higher than that of group A, and with the increase in the number of injection, the difference is more obvious, 1 month after the third injection, the difference of BCVA between the two groups was the most significant (F=7.20, 8.28, 9.01, 12.68; P<0.05).

Conclusion

Intravitreal injection of Compaq is safe and effective in the treatment of secondary CRVO and BRVO with ME. and the treatment effect of BRVO is more significant than that of CRVO patients.

Key words: Intravitreal injection, Compaq, Retinal vein occlusion, Macular edema

[1]	Wong TY, Scott IU. Retinal－Vein Occlusion[J]. New England Journal of Medicine, 2010, 363(22):2135-2144.
[2]	Wang Q, Li T, Wu Z, et al. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti－angiogenesis effect in vivo[J]. Plos One, 2013, 8(8):e70544.
[3]	Yoshioka E, Yamaguchi M, Shiraishi A, et al. Influence of Eyelid Pressure on Fluorescein Staining of Ocular Surface in Dry Eyes.[J]. Am J Ophthalmol, 2015, 160(4):685-692.
[4]	Rehak J, Rehak M. Branch Retinal Vein Occlusion: Pathogenesis, Visual Prognosis, and Treatment Modalities[J]. Current Eye Research, 2008, 33(2):111-131.
[5]	陈甲兴，唐宁. 视网膜静脉阻塞相关因素的临床观察[J]. 国际眼科杂志，2014,14(2):354-357.
[6]	张惠蓉，夏英杰. 视网膜静脉阻塞患者视力预后相关因素分析[J]. 中华眼科杂志，2002,38(2):98-102.
[7]	张惠蓉，王欣，鹿新荣，等. 视网膜静脉阻塞致黄斑水肿患者相干光断层扫描和视力预后观察[J]. 中华眼科杂志，2005,41(10):910-916.
[8]	Bhisitkul RB, Campochiaro PA, Shapiro H, et al. Predictive value in retinal vein occlusions of early versus late or incomplete ranibizumab response defined by optical coherence tomography[J]. Ophthalmology, 2013, 120(5):1057-1063.
[9]	Wroblewski JJ, Rd WJ, Gonzales CR. Pegaptanib sodium for macular edema secondary to branch retinal vein occlusion[J]. Am J Ophthalmol, 2009, 127(4):374-380.
[10]	严密，廖菊生. 视网膜静脉阻塞认识和治疗方法的争议[J]. 中华眼底病杂志，2007,23(3):55-158.
[11]	The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion[J]. Am J Ophthalmol, 1984, 98(3):271-282.
[12]	白石. 不同方法治疗视网膜分支静脉阻塞继发黄斑水肿的疗效[J]. 国际眼科杂志，2017,17(4):648-651.
[13]	Arnarsson A, Stefánsson E. Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2000, 41(3):877-879.
[14]	王文吉. 视网膜静脉阻塞[J]. 中国眼耳鼻喉科杂志，2012,12(2):78-81.
[15]	The Central Vein Occlusion Study Group M report. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion[J]. Ophthalmology, 1995, 102(10):1425-1433.
[16]	刘卫. 视网膜静脉阻塞继发黄斑水肿的治疗进展[J]. 中华眼底病杂志，2013,29(6):785-788.
[17]	Domalpally A, Blodi BA, Scott IU, et al. A Randomized Trial Comparing the Efficacy and Safety of Intravitreal Triamcinolone With Observation to Treat Vision Loss Associated With Macular Edema Secondary to Central Retinal Vein Occlusion[J]. Evidence－Based Ophthalmology, 2009, 11(1):22-23.
[18]	何勤，王林，柯根杰，等. 康柏西普单次玻璃体腔注射治疗视网膜静脉阻塞伴黄斑水肿[J]. 实用防盲技术，2016,11(2):69-71.
[19]	Yeh WS, Haller JA, Lanzetta P, et al. Effect of the Duration of Macular Edema on Clinical Outcomes in Retinal Vein Occlusion Treated with Dexamethasone Intravitreal Implant[J]. Ophthalmology, 2012, 119(6):1190-1198.
[20]	Le MO, Duncombe A, Portmann A, et al. Role of intravitreal bevacizumab for resistant macular edema due to central retinal vein occlusion after failure of intravitreal triamcinolone acetonide.[J]. Journal Franais Dophtalmologie, 2012, 35(9):700-704.
[21]	张菁，蔡小军，陈晓敏，等. 玻璃体腔注射康柏西普联合视网膜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):22-26.
[22]	Tan MH, McAllister IL, Gillies ME, et al. Randomized controlled trial of intravitreal ranibizumab versus standard grid laser for macular edema following branch retinal vein occlusion[J]. Am J Ophthalmol, 2014, 157(1):237-247.
[23]	杨林红，皇甫昌涛，朱琳，等. 眼内注射康柏西普治疗视网膜分支静脉阻塞继发黄斑水肿的临床观察[J]. 昆明医科大学学报，2015,36(11):147-149.
[24]	Alon T, Hemo I, Itin A, et al. Vascular endothelial growth factor acts as a survival factor for newly formed retinal vessels and has implications for retinopathy of prematurity[J]. Nature Medicine, 1995, 1(10):1024-1028.
[25]	邵彦，李筱荣. 抗血管内皮生长因子药物治疗年龄相关性黄斑变性的现状[J]. 眼科，2007,16(4):282-284.
[26]	孙晓东，宋正宇，汪枫桦. 抗血管内皮生长因子A药物治疗年龄相关性黄斑变性随访及再治疗的策略[J]. 中华实验眼科杂志，2012,30(5):385-387.
[27]	Chen Y, Wiesmann C, Fuh G, et al. Selection and analysis of an optimized anti－VEGF antibody: crystal structure of an affinity－matured fab in complex with antigen 1[J]. Journal of Molecular Biology, 1999, 293(4):865-881.
[28]	Emerson MV, Lauer AK. Emerging Therapies for the Treatment of Neovascular Age－Related Macular Degeneration and Diabetic Macular Edema[J]. Biodrugs Clinical Immunotherapeutics Biopharmaceuticals & Gene Therapy, 2007, 21(4):245-257.
[29]	Lu X, Sun X. Profile of conbercept in the treatment of neovascular age－related macular degeneration[J]. Drug Design Development & Therapy, 2015, 9(2):2311-2320.
[30]	Pauleikhoff D, Kirchhof B, Bertram B, et al. New aspects in the treatment of neovascular age－related macular degeneration: the criteria of re－treatment with the anti－VEGF therapy[J]. Der Ophthalmologe, 2011, 108(1):85-90.
[31]	Papadopoulos N, Martin J, Ruan Q, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab[J]. Angiogenesis, 2012, 15(2):171-185.
[32]	Spilsbury K, Garrett KL, Shen WY, et al. Overexpression of Vascular Endothelial Growth Factor (VEGF) in the Retinal Pigment Epithelium Leads to the Development of Choroidal Neovascularization[J]. American Journal of Pathology, 2000, 157(1):135-144.
[33]	钱彤，黎晓新，尹虹，等. 玻璃体腔注射avastin治疗视网膜分支静脉阻塞继发黄斑水肿疗效观察[J]. 中华实验眼科杂志，2010,28(1):79-82.
[34]	王馨. 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]. 中国实用医药，2017,12(2):110-112.
[35]	宋莉，沙翔垠，郑瑜，等. 康柏西普治疗视网膜分支静脉阻塞继发黄斑水肿疗效分析[J]. 广东医学，2017,38(5):778-780.
[36]	Singer MA, Cohen SR, Groth SL, et al. Comparing bevacizumab and ranibizumab for initial reduction of central macular thickness in patients with retinal vein occlusions[J]. Clinical Ophthalmology, 2013, 7(1):1377-1383.
[37]	Gerding H. Results of a Meta－Analysis on Intravitreal anti－VEGF Treatment of Macular Oedema Secondary to Branch Retinal Vein Occlusion (BRVO)[J]. Klin Monatsbl Augenheilkd, 2017, 234(4):551-555.
[38]	Gerding H. Intravitreal anti－VEGF Treatment in Central Retinal Vein Occlusion (CRVO): a Meta－Analysis of One Year Results[J]. Klinische Monatsblatter Fur Augenheilkunde, 2017, 234(4):546-550.
[39]	Tsai RYL. Balancing self－renewal against genome preservation in stem cells: How do they manage to have the cake and eat it too？[J]. Cellular & Molecular Life Sciences, 2016, 73(9):1803-1823.
[40]	Tsai RYL. A molecular view of stem cell and cancer cell self－renewal[J]. International Journal of Biochemistry & Cell Biology, 2004, 36(4):684-694.

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Efficacy of intravitreal injection of Compaq in the treatment of macular edema associated with different types of retinal vein occlusion

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Efficacy of intravitreal injection of Compaq in the treatment of macular edema associated with different types of retinal vein occlusion