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中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (03) : 134 -139. doi: 10.3877/cma.j.issn.2095-2007.2022.03.002

论著

继发黄斑水肿的视网膜中央静脉阻塞患眼脉络膜厚度的变化及雷珠单抗治疗效果的临床研究
黄瑶1, 侯思梦1, 魏文斌1,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　眼内肿瘤诊治研究北京市重点实验室　北京市眼科学与视觉科学重点实验室　医学人工智能研究与验证工信部重点实验室
  • 收稿日期:2022-04-16 出版日期:2022-06-28
  • 通信作者: 魏文斌
  • 基金资助:
    首都卫生发展科研专项项目(首发2020－1－2052); 北京市科委科技计划项目(Z201100005520045); 北京市科委科技计划项目(Z181100001818003); 中央保健科研课题(2020YB49)

The therapeutic effect of ranibizumab on the change of choroidal thickness in eyes with macular edema secondary to central retinal vein occlusion

Yao Huang1, Simeng Hou1, Wenbin Wei1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab., Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing 100730, China
  • Received:2022-04-16 Published:2022-06-28
  • Corresponding author: Wenbin Wei
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黄瑶, 侯思梦, 魏文斌. 继发黄斑水肿的视网膜中央静脉阻塞患眼脉络膜厚度的变化及雷珠单抗治疗效果的临床研究[J]. 中华眼科医学杂志(电子版), 2022, 12(03): 134-139.

Yao Huang, Simeng Hou, Wenbin Wei. The therapeutic effect of ranibizumab on the change of choroidal thickness in eyes with macular edema secondary to central retinal vein occlusion[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(03): 134-139.

目的

探讨继发黄斑水肿的视网膜中央静脉阻塞(CRVO)患者脉络膜厚度的变化及雷珠单抗的治疗效果。

方法

收集2019年11月至2021年10月在首都医科大学附属北京同仁医院眼科中心接受玻璃体腔注射雷珠单抗治疗CRVO继发黄斑水肿的患者54例(54只眼)。其中，男性30例(30只眼)，女24例(24只眼)；年龄25~71岁，平均年龄(55.27±12.03)岁。全部患眼均采用玻璃体腔内注射雷珠单抗治疗，治疗方案为前3个月，每个月注射一次，3个月后根据患者的病情按需注射。全部患者均随访6个月。检测并记录患眼治疗前后的黄斑中心凹视网膜厚度(CFT)；检测并记录患眼及对侧眼治疗前后的黄斑中心凹下脉络膜厚度(SFCT)。CFT和SFCT的检查结果经检验符合正态分布，以±s表示。患眼治疗前后CFT的比较、患眼治疗前后SFCT的比较、治疗前患眼与对侧眼SFCT的比较及治疗后患眼与对侧眼SFCT的比较，均采用配对样本t检验。

结果

治疗前，患眼的CFT为(653.37±235.46)μm；治疗后1个月、2个月、3个月、4个月、5个月及6个月时，患眼的CFT分别为(342.36±136.54)μm、(265.31±94.87)μm、(253.01±181.26)μm、(313.54±102.43)μm、(251.12±98.34)μm及(226.13±70.18)μm，与治疗前比较患眼的CFT均变薄，其差异具有统计学意义(t＝8.397，11.233，9.901，9.725，11.584，12.778；P<0.05)。治疗前，患眼和对侧眼的SFCT分别为(323.27±52.24)μm和(253.26±70.13)μm；治疗后1个月、2个月、3个月、4个月、5个月及6个月时患眼的SFCT分别为(261.32±80.17)μm、(243.16±65.23)μm、(249.26±59.32)μm、(251.21±72.28)μm、(263.52±63.74)μm及(256.53±72.19)μm；对侧眼的SFCT分别为(251.34±43.26)μm、(254.27±44.16)μm、(252.64±48.27)μm、(251.67±32.89)μm、(252.45±52.36)μm及(253.79±42.57)μm。患眼治疗后1个月、2个月、3个月、4个月、5个月及6个月时的SFCT均较治疗前变薄，其差异均具有统计学意义(t＝ 4.758，7.044，6.881，5.938，5.328，5.504；P<0.05)。治疗前患眼的SFCT较对侧眼厚，其差异具有统计学意义(t＝5.883，P<0.05)。治疗后，患眼与对侧眼SFCT的比较差异均无统计学意义(t＝0.805，－1.036，－0.325，－0.043，1.134，0.240；P>0.05)。说明治疗前患眼脉络膜水肿增厚，经治疗患眼脉络膜水肿消退恢复至对侧眼的厚度。

结论

继发黄斑水肿的CRVO患者脉络膜也出现水肿；玻璃体腔注射雷珠单抗在减轻黄斑视网膜水肿的同时亦可减轻脉络膜水肿。

关键词: 视网膜中央静脉阻塞, 雷珠单抗, 黄斑中心凹视网膜厚度, 中心凹下脉络膜厚度
Objective

To investigate therapeutic effect of ranibizumab on the change of sub-foveal choroidal thickness (SFCT) in eyes with macular edema secondary to central retinal vein occlusion (CRVO).

Methods

From November 2019 to October 2021, 54 patients (54 eyes) with macular edema secondary to CRVO received intravitreal injection of ranibizumab in the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University. Among them, there were 30 males (30 eyes) and 24 females (24 eyes) with the average age of (55.27±12.03) years-old (ranged from 25 to 71 years-old). All eyes were treated with intravitreal injection of ranibizumab. The treatment scheme was once a month for the first 3 months, and then injected as needed according to the patient′s condition after 3 months. All patients were followed up for 6 months. The foveal retinal thickness (CFT) and the macular foveal choroidal thickness (SFCT) of patients were recorded and measured before and after treatment. The data of CFT and SFCT conform to the normal distribution after inspection, and were expressed by ±s. The comparison of CFT, SFCT before and after treatment, SFCT between the affected eye and the contralateral eye before treatment, and SFCT between the affected eye and the contralateral eye after treatment were all performed by paired sample t test.

Results

Before treatment, the CFT of the affected eye was (653.37±235.46)μm. After treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, the CFT of the affected eyes were (342.36±136.54)μm, (265.31±94.87)μm, (253.01±181.26)μm, (313.54±102.43)μm, (251.12±98.34)μm and (226.13±70.18)μm, respectively. The CFT of the affected eyes was thinner than that before treatment, and the difference was statistically significant (t=(8.397), 11.233, 9.901, 9.725, 11.584, 12.778; P<0.05). Before treatment, the SFCT of the affected eye and the contralateral eye were (323.27±52.24)μm and (253.26±70.13)μm. The SFCT of the affected eyes after treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months were (261.32±80.17)μm, (243.16±65.23)μm, (249.26±59.32)μm、(251.21±72.28)μm, (263.52±63.74)μm and (256.53±72.19)μm, respectively. The SFCT of contralateral eyes were (251.34±43.26)μm, (254.27±44.16)μm, (252.64±48.27)μ m, (251.67±32.89)μm, (252.45±52.36)μm and (253.79±42.57)μm, respectively. SFCT of the affected eye after treatment for 1 month, 2 months, 3 months, 4 months, 5 months and 6 months was thinner than that before treatment, and the difference was statistically significant (t=4.758, 7.044, 6.881, 5.938, 5.328, 5.504; P<0.05). Before treatment, SFCT of the affected eye was thicker than that of the contralateral eye, and the difference was statistically significant (t=5.883, P<0.05). After treatment, there was no significant difference in SFCT between the affected eye and the contralateral eye (t=0.805, -1.036, -0.325, -0.043, 1.134, 0.240; P>0.05), which indicating that before treatment, the choroidal edema of the affected eye thickened, and after treatment, the choroidal edema of the affected eye subsided and recovered to the thickness of the contralateral eye.

Conclusions

There also occurred choroidal edema in patients with macular edema secondary to CRVO, and intravitreal injection of ranibizumab could reduce macular retinal edema and choroidal edema at the same time.

Key words: Retinal vein occlusion, Ranibizumab, Central fovea thickness, Subfoveal choroidal thickness
表1 患眼治疗前后CFT及SFCT的比较(±s，μm)
时间 眼数(只眼) CFT SFCT
治疗前 54 653.37±235.46 323.27±52.24
治疗后      
  1个月 54 342.36±136.54 261.32±80.17
  2个月 54 265.31± 94.87 243.16±65.23
  3个月 54 253.01±181.26 249.26±59.32
  4个月 54 313.54±102.43 251.21±72.28
  5个月 54 251.12± 98.34 263.52±63.74
  6个月 54 226.13± 70.18 256.53±72.19
t0, 1值   8.397 4.758
t0, 2值   11.233 7.044
t0, 3值   9.901 6.881
t0, 4值   9.725 5.938
t0, 5值   11.584 5.328
t0, 6值   12.778 5.504
P0, 1值   <0.05 <0.05
P0, 2值   <0.05 <0.05
P0, 3值   <0.05 <0.05
P0, 4值   <0.05 <0.05
P0, 5值   <0.05 <0.05
P0, 6值   <0.05 <0.05
图1 雷珠单抗注射前和注射后1~6个月患眼黄斑中心凹视网膜厚度的变化趋势图
图2 雷珠单抗注射前和注射后患眼1~6个月黄斑中心凹下脉络膜厚度的变化趋势图
表2 CRVO患者患眼及对侧眼雷珠单抗治疗前后SFCT的比较(±s，μm)
眼别 眼数(只) 注射前 注射后1个月 注射后2个月 注射后3个月 注射后4个月 注射后5个月 注射后6个月
患眼 54 323.27±52.24 261.32±80.17 243.16±65.23 249.26±59.32 251.21±72.28 263.52±63.74 256.53±72.19
对侧眼 54 253.26±70.13 251.34±43.26 254.27±44.16 252.64±48.27 251.67±32.89 252.45±52.36 253.79±42.57
t值   5.883 0.805 －1.036 －0.325 －0.043 1.134 0.240
P值   <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
[1]
Yeh S, Kim SJ, Ho AC, et al. Therapies for macular edema associated with central retinal vein occlusion: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2015, 122(4): 769-778.
[2]
Varma R, Bressler NM, Suñer I, et al. Improved vision－related function after ranibizumab for macular edema after retinal vein occlusion: results from the BRAVO and CRUISE trials[J]. Ophthalmology, 2012, 119(10): 2108-2118.
[3]
Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond[J]. Surv Ophthalmol, 2013, 58(5): 387-429.
[4]
Lee EK, Han JM, Hyon JY, et al. Changes in choroidal thickness after intravitreal dexamethasone implant injection in retinal vein occlusion[J]. Br J Ophthalmol, 2015, 99(11): 1543-1549.
[5]
Kang HM, Kwon HJ, Yi JH, et al. Subfoveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age－related macular degeneration[J]. Am J Ophthalmol, 2014, 157(5): 1013-1021.
[6]
Adhi M, Brewer E, Waheed NK, et al. Analysis of morphological features and vascular layers of choroid in diabetic retinopathy using spectral－domain optical coherence tomography[J]. JAMA Ophthalmol, 2013, 131(10): 1267-1274.
[7]
Manjunath V, Goren J, Fujimoto JG, et al. Analysis of choroidal thickness in age－related macular degeneration using spectral－domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 152(4): 663-668.
[8]
Yang L, Jonas JB, Wei W. Optical coherence tomography assisted enhanced depth imaging of central serous chorioretinopathy[J]. Invest Ophthalmol Vis Sci, 2013, 54(7): 4659-4665.
[9]
Erogul O, Yozgat Z, Sabaner MC, et al. The effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion[J]. Niger J Clin Pract, 2021, 24(1): 121-126.
[10]
Esen E, Sizmaz S, Demircan N. Choroidal thickness changes after intravitreal dexamethasone implant injection for the treatment of macular edema due to retinal vein occlusion[J]. Retina, 2016, 36(12): 2297-2303
[11]
Tsuiki E, Suzuma K, Ueki R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central retinal vein occlusion[J]. Am J Ophthalmol, 2013, 156(3): 543-547.
[12]
Noma H, Mimura T, Eguchi S. Association of inflammatory factors with macular edema in branch retinal vein occlusion[J]. JAMA Ophthalmol, 2013, 131(2): 160-165.
[13]
Du KF, Xu L, Shao L, et al. Subfoveal choroidal thickness in retinal vein occlusion[J]. Ophthalmology, 2013, 120(12): 2749-2750.
[14]
Sodi A, Lenzetti C, Murro V, et al. EDI－OCT evaluation of choroidal thickness in retinitis pigmentosa[J]. Eur J Ophthalmol, 2018, 28(1): 52-57.
[15]
Yang L, Jonas JB, Wei W. Choroidal vessel diameter in central serous chorioretinopathy[J]. Acta Ophthalmol, 2013, 91(5): e358-e362.
[16]
Manjunath V, Goren J, Fujimoto JG, et al. Analysis of choroidal thickness in age－related macular degeneration using spectral domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 152 (4): 663-668.
[17]
Jonas JB, Forster TM, Steinmetz P, et al. Choroidal thickness in age－related macular degeneration[J]. Retina, 2014, 34(6): 1149-1155.
[18]
Wei WB, Xu L, Jonas JB, et al. Subfoveal choroidal thickness: the Beijing Eye Study[J]. Ophthalmology, 2013, 120(1): 175-180.
[19]
Yang L, Jonas JB, Wei W. Optical coherence tomography－assisted enhanced depth imaging of central serous chorioretinopathy[J]. Invest Ophthalmol Vis Sci, 2013, 54(7): 4659-4665.
[20]
Nishinaka A, Inoue Y, Fuma S，et al. Pathophysiological role of VEGF on retinal edema and nonperfused areas in mouse eyes with retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2018, 59 (11): 4701-4713.
[21]
Mitamura Y, Enkhmaa T, Sano H, et al. Changes in choroidal structure following intravitreal aflibercept therapy for retinal vein occlusion[J]. Br J Ophthalmol, 2021, 105(5): 704-710.
[22]
Aiello LP, Northrup JM, Keyt BA，et al. Hypoxic regulation of vascular endothelial growth factor in retinal cells[J]. Arch Ophthalmol, 1995, 113(12): 1538-1544.
[23]
Julien S, Biesemeier A, Taubitz T, et al. Different effects of intravitreally injected ranibizumab and aflflibercept on retinal and choroidal tissues of monkey eyes[J]. Br J Ophthalmol, 2014, 98(6): 813-825.
[24]
Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a predictor for response to anti－vascular endothelial growth factor therapy in diabetic macular edema[J]. Am J Ophthalmol, 2015, 159(1): 85-91.
[25]
Bonnin P, Pournaras JA, Makowiecka K, et al. Ultrasound assessment of ocular vascular effects of repeated intravitreal injections of ranibizumab for wet age－related macular degeneration[J]. Acta Ophthalmol, 2014, 92(5): e382-e387.
[26]
Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a short－term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion[J]. Br J Ophthalmol, 2019, 103(1): 55-59.
[27]
Tang F, Xu F, Zhong H, et al. Comparison of subfoveal choroidal thickness in eyes with CRVO and BRVO[J]. BMC Ophthalmol, 2019, 19(1): 133-139.
[28]
Saint－Geniez M, Maldonado AE, D'Amore PA. VEGF expression and receptor activation in the choroid during development and in the adult[J]. Invest Ophthalmol Vis Sci, 2006, 47(7): 3135-3142.
[29]
Marneros AG, Fan J, Yokoyama Y, et al. Vascular endothelial growth factor expression in the retinal pigment epithelium is essential for choriocapillaris development and visual function[J]. Am J Pathol. 2005, 167(5): 1451-1459.
[30]
Pe'er J, Shweiki D, Itin A, et al. Hypoxia－induced expression of vascular endothelial growth factor by retinal cells is a common factor in neovascularizing ocular diseases[J]. Lab Invest, 1995, 72(6): 638-645.
[31]
Okamoto M, Yamashita M, Sakamoto T, et al. Choroidal blood flow and thickness as predictors for response to anti－vascular endothelial growth factor therapy in macular edema secondary to branch retinal vein occlusion[J]. Retina, 2018, 38(3): 550-558.
[32]
Hasegawa T, Kawano T, Maruko I, et al. Clinical findings of eyes with macular edema associated with branch retinal vein occlusion refractory to ranibizumab[J]. Retina, 2018, 38(7): 1347-1353.
[33]
Usui S, Ikuno Y, Akiba M, et al. Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects[J]. Invest Ophthalmol Vis Sci, 2012, 53(4): 2300-2307.
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