高级检索
中华实验眼科杂志
期刊首页
过刊列表
高级检索
稿件发表
• 临床研究 •
ENGLISH ABSTRACT
康柏西普玻璃体腔注射联合曲安奈德后Tenon囊下注射对非缺血型BRVO继发黄斑水肿的疗效评估
解瑞
原丽
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20200229-00124
Evaluation of efficacy of combination therapy of intravitreal conbercept with posterior sub-Tenon triamcinolone acetonide for treatment of macular edema secondary to non-ischemic branch retinal vein occlusion
Xie Rui
Yuan Li
Authors Info & Affiliations
Xie Rui
Department of Ophthalmology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, China
Yuan Li
Department of Physiology, Changzhi Medical College, Changzhi 046000, China
·
DOI： 10.3760/cma.j.cn115989-20200229-00124
394
47
0
0
3
0
PDF下载
APP内阅读
摘要

目的评估康柏西普玻璃体腔注射(IVC)联合曲安奈德后Tenon囊下注射(PSTA)治疗非缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床疗效。

方法采用非随机对照临床研究，纳入2016年10月至2019年11月于长治医学院附属和平医院眼科就诊的单眼非缺血型BRVO继发黄斑水肿患者59例59眼，根据注射药物不同分为IVC组28眼和IVC+PSTA组31眼。IVC组采用1+按需(PRN)方案给予IVC治疗，IVC+PSTA组首次治疗给予IVC联合PSTA治疗，之后按PRN方案仅予以IVC治疗。比较2个组注射前和注射后1、3、6个月最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、眼压变化及重复注射次数，观察2个组眼部并发症。

结果2个组BCVA组间总体比较差异无统计学意义，不同时间点BCVA总体比较差异有统计学意义( F 分组＝0.464， P＝0.498； F 时间＝25.454， P<0.001)，2个组注射后不同时间点BCVA均较注射前明显提高，差异均有统计学意义(均 P<0.001)。2个组注射前后不同时间点CMT总体比较差异均有统计学意义( F 分组＝6.208， P＝0.016； F 时间＝155.505， P<0.001)，2个组注射后不同时间点CMT均较注射前明显降低，注射后1个月和3个月IVC+PSTA组CMT值小于IVC组，差异均有统计学意义(均 P<0.05)。2个组眼压总体比较差异有统计学意义，不同时间点眼压比较差异无统计学意义( F 分组＝9.994， P＝0.006； F 时间＝2.679， P＝0.056)，其中注射后1个月和3个月IVC+PSTA组眼压高于IVC组，差异均有统计学意义(均 P<0.01)；IVC+PSTA组有4眼眼压>21 mmHg(1 mmHg＝0.133 kPa)。6个月随访期内，IVC组平均重复注射(1.25±0.93)次，多于IVC+PSTA组的(0.61±0.72)次，差异有统计学意义( P＝0.039)。2个组患者均未见其他眼部并发症。

结论IVC联合PSTA可明显改善非缺血型BRVO患者的视力和黄斑水肿程度，单次PSTA早期可强化康柏西普缓解黄斑水肿的作用，短期内减少康柏西普重复注射次数。

视网膜静脉阻塞;黄斑水肿;康柏西普;曲安奈德;后Tenon囊下注射
ABSTRACT

ObjectiveTo evaluate the efficacy of combination therapy of intravitreal conbercept (IVC) with posterior sub-Tenon injection of triamcinolone acetonide (PSTA) in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO).

MethodsA nonrandomized controlled study was conducted.Fifty-nine patients (59 eyes) diagnosed with macular edema secondary to non-ischemic BRVO were enrolled in Heping Hospital Affiliated to Changzhi Medical College from October 2016 to November 2019.The subjects were divided into IVC group (28 eyes) and combination therapy of IVC with PSTA group (IVC+ PSTA group for short) (31 eyes). IVC group received IVC 0.5 mg and IVC+ PSTA group received IVC 0.5 mg combined with PSTA 40 mg as the initial therapy, then a pro re nata (PRN) IVC administration was adopted for the two groups.The mean best corrected visual acuity (BCVA) converted to the logarithm of the minimum angle of resolution unit, central macular thickness (CMT) and intraocular pressure (IOP) before and 1, 3, 6 months after injection were measured and compared.The number of repeated IVC injections and relevant complications were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Heping Hospital Affiliated to Changzhi Medical College (No.20160R9). Written informed consent was obtained from each subject prior to any medical examination.

ResultsThere was a statistically significant difference in BCVA between the two groups among different time points ( F group=0.464, P=0.498; F time=25.454, P<0.001). Compared with before injection, the BCVA of both groups was significantly improved at each time point after injection (all at P<0.001). There was a statistically significant difference in CMT between the two groups among different time points ( F group=6.208, P=0.016; F time=155.505, P<0.001). The CMT of both groups at each time point after injection was significantly smaller than that before injection, and the CMT in IVC+ PSTA group at 1 and 3 months after injection was smaller than that in IVC group (all at P<0.05). There was a statistically significant overall difference in IOP between the two groups ( F group=9.994, P=0.006; F time=2.679, P=0.056). At 1 and 3 months after injection, the IOP in IVC+ PSTA group was higher than that in IVC group, showing statistically significant differences (both at P<0.01). There were 4 eyes with an IOP higher than 21 mmHg (1 mmHg=0.133 kPa) in IVC+ PSTA group.Within the 6-month follow-up, the mean number of repeated IVC injections of IVC group was 1.25±0.93, which was higher than 0.61±0.72 of IVC+ PSTA group, and the difference was statistically significant ( P=0.039). No other ocular complication was observed in both groups.

ConclusionsCombination therapy of IVC with PSTA is effective in improving the BCVA and macular edema of patients with macular edema secondary to non-ischemic BRVO.A single PSTA injection can enhance the effect of conbercept in reliving macular edema in early months and reduce the number of repeated conbercept injections in the short term.

Retinal vein occlusion;Macular edema;Conbercept;Triamcinolone acetonide;Posterior sub-Tenon injection
Yuan Li, Email: mocdef.3ab614002.oaijgnehz
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

解瑞,原丽. 康柏西普玻璃体腔注射联合曲安奈德后Tenon囊下注射对非缺血型BRVO继发黄斑水肿的疗效评估[J]. 中华实验眼科杂志,2022,40(12)：1149-1156.

DOI:10.3760/cma.j.cn115989-20200229-00124

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

视网膜静脉阻塞(retinal vein occlusion，RVO)是临床上常见的视网膜血管性疾病，其中视网膜分支静脉阻塞(branch retinal vein occlusion，BRVO)约占80% [ 1 ]。黄斑水肿是BRVO的主要并发症之一。目前，抗血管内皮生长因子(vascular endothelial growth factor，VEGF)药物已逐渐成为RVO继发黄斑水肿的主要治疗方式，但临床工作中发现，眼内反复多次注射和较大的经济负担仍然是患者对治疗依从性差的主要原因 [ 2 ]。长效糖皮质激素曲安奈德(triamcinolone acetonide，TA)玻璃体腔注射(intravitreal triamcinolone acetonide，IVTA)治疗RVO继发黄斑水肿被证实有效，且TA与抗VEGF药物联合玻璃体腔注射，作用相当或优于抗VEGF单药，并可减少抗VEGF药物的重复注射次数 [ 3 , 4 ]，但IVTA治疗可引起青光眼、白内障、感染性眼内炎及视网膜脱离等并发症，限制了其临床应用 [ 5 , 6 ]。研究表明，TA后Tenon囊下注射(posterior sub-Tenon injection of triamcinolone acetonide，PSTA)对黄斑水肿的疗效接近于IVTA，同时并发症少于IVTA [ 7 ]，但PSTA联合抗VEGF药物治疗RVO的相关研究少见。本研究拟评估康柏西普玻璃体腔注射(intravitreal conbercept，IVC)联合PSTA治疗非缺血型BRVO继发黄斑水肿的临床疗效。
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Rogers SL , McIntosh RL , Lim L ，et al. Natural history of branch retinal vein occlusion：an evidence-based systematic review[J]．Ophthalmology， 2010，117(6)∶1094-1101. DOI： 10.1016/j.ophtha.2010.01.058 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Ghoraba HH , Leila M , Elgouhary SM ，et al. Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries[J]．Clin Ophthalmol， 2018，12∶2383-2391. DOI： 10.2147/OPTH.S185274 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Ang JL , Ah-Moye S , Kim LN ，et al. A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion[J]．Eye (Lond)， 2020，34(10)∶1770-1796. DOI： 10.1038/s41433-020-0861-9 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Osaka R , Muraoka Y , Nakano Y ，et al. One-year results of anti-vascular endothelial growth factor therapy combined with triamcinolone acetonide for macular edema associated with branch retinal vein occlusion[J]．Jpn J Ophthalmol， 2020，64(6)∶605-612. DOI： 10.1007/s10384-020-00765-w .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Thorne JE , Sugar EA , Holbrook JT ，et al. Periocular triamcinolone vs .intravitreal triamcinolone vs .intravitreal dexamethasone implant for the treatment of uveitic macular edema：the periocular vs .intravitreal corticosteroids for uveitic macular edema (POINT) trial [J]．Ophthalmology， 2019，126(2)∶283-295. DOI： 10.1016/j.ophtha.2018.08.021 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Yumusak E , Buyuktortop N , Ornek K ．Early results of dexamethasone implant，ranibizumab，and triamcinolone in macular edema due to branch retinal vein occlusion[J]．Eur J Ophthalmol， 2016，26(1)∶54-59. DOI： 10.5301/ejo.5000637 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Tatsumi T , Oshitari T , Ando T ，et al. Comparison of the efficacy of sub-Tenon versus intravitreal triamcinolone acetonide injection during cataract surgery for diabetic macular edema[J]．Ophthalmologica， 2019，241(1)∶17-23. DOI： 10.1159/000489716 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
王玲．玻璃体腔注射抗血管内皮生长因子药物的标准操作规范及眼部并发症[J]．中国眼耳鼻喉科杂志， 2015，15(4)∶267-269. DOI： 10.14166/j.issn.1671-2420.2015.04.011 .
返回引文位置Google Scholar
百度学术
万方数据
Wang L ．Standard operation procedure and severe adverse effects of intravitreous injection of anti-vascular endothelial growth factor agents[J]．Chin J Ophthalmol Otorhinolaryngol， 2015，15(4)∶267-269. DOI： 10.14166/j.issn.1671-2420.2015.04.011 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[9]
Moon J , Kim M , Sagong M ．Combination therapy of intravitreal bevacizumab with single simultaneous posterior subtenon triamcinolone acetonide for macular edema due to branch retinal vein occlusion[J]．Eye (Lond)， 2016，30(8)∶1084-1090. DOI： 10.1038/eye.2016.96 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Sun Z , Zhou H , Lin B ，et al. Efficacy and safety of intravitreal conbercept injections in macular edema secondary to retinal vein occlusion[J]．Retina， 2017，37(9)∶1723-1730. DOI： 10.1097/IAE.0000000000001404 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Li F , Sun M , Guo J ，et al. Comparison of conbercept with ranibizumab for the treatment of macular edema secondary to branch retinal vein occlusion[J]．Curr Eye Res， 2017，42(8)∶1174-1178. DOI： 10.1080/02713683.2017.1285943 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Gutman FA . Macular edema in branch retinal vein occlusion：prognosis and management[J]．Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol， 1977，83(3Pt 1)∶488-495.
返回引文位置Google Scholar
百度学术
万方数据
[13]
Nicolò M , Ferro Desideri L , Vagge A ，et al. Faricimab：an investigational agent targeting the Tie-2/angiopoietin pathway and VEGF-A for the treatment of retinal diseases[J]．Expert Opin Investig Drugs， 2021，30(3)∶193-200. DOI： 10.1080/13543784.2021.1879791 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Feltgen N , Pielen A ．Retinal vein occlusion：epidemiology，classification and clinical findings[J]．Ophthalmologe， 2015，112(7)∶607-618； 10.1007/s00347-015-0105-8 . DOI：.
返回引文位置Google Scholar
百度学术
万方数据
[15]
Wang B , Fang S , Chen L ．Intravitreal injection of conbercept combined with retinal photocoagulation on macular edema secondary to branch retinal vein occlusion[J]．Exp Ther Med， 2020，19(6)∶3537-3542. DOI： 10.3892/etm.2020.8660 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Tang F , Qin X , Lu J ，et al. Optical coherence tomography predictors of short-term visual acuity in eyes with macular edema secondary to retinal vein occlusion treated with intravitreal conbercept[J]．Retina， 2020，40(4)∶773-785. DOI： 10.1097/IAE.0000000000002444 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Scott IU , VanVeldhuisen PC , Ip MS ，et al. Effect of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal vein occlusion：the SCORE2 randomized clinical trial [J]．JAMA， 2017，317(20)∶2072-2087. DOI： 10.1001/jama.2017.4568 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Miwa Y , Muraoka Y , Osaka R ，et al. Ranibizumab for macular edema after branch retinal vein occlusion：one initial injection versus three monthly injections[J]．Retina， 2017，37(4)∶702-709. DOI： 10.1097/IAE.0000000000001224 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Kola M , Hacioglu D , Turk A ，et al. The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema[J]．Cutan Ocul Toxicol， 2016，35(3)∶185-189. DOI： 10.3109/15569527.2015.1074586 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Watanabe A , Tsuzuki A , Arai K ，et al. Efficacy of intravitreal triamcinolone acetonide for diabetic macular edema after vitrectomy[J]．J Ocul Pharmacol Ther， 2016，32(1)∶38-43. DOI： 10.1089/jop.2015.0045 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Kim MW , Moon H , Yang SJ ，et al. Effect of posterior subtenon triamcinolone acetonide injection on diabetic macular edema refractory to intravitreal bevacizumab injection[J]．Korean J Ophthalmol， 2016，30(1)∶25-31. DOI： 10.3341/kjo.2016.30.1.25 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Shen L , Mao J , Chen Y ，et al. Transscleral permeation of subtenon triamcinolone in different vitreoretinal diseases[J]．Ophthalmology， 2015，122(3)∶649-651. DOI： 10.1016/j.ophtha.2014.09.027 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Sohn HJ , Han DH , Lee DY ，et al. Changes in aqueous cytokines after intravitreal triamcinolone versus bevacizumab for macular oedema in branch retinal vein occlusion[J/OL]．Acta Ophthalmol， 2014，92(3)∶e217-e224[2022－04－20]．https://pubmed.ncbi.nlm.nih.gov/23889803/. DOI： 10.1111/aos.12219 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
马锋伟，杜翠云，程美红，等．康柏西普与曲安奈德玻璃体腔注射治疗视网膜中央静脉阻塞继发黄斑水肿临床疗效的比较[J]．中华实验眼科杂志， 2016，34(9)∶837-841. DOI： 10.3760/cma.j.issn.2095-0160.2016.09.013 .
返回引文位置Google Scholar
百度学术
万方数据
Ma FW , Du CY , Cheng MH ，et al. A comparative study onconbercept and triamcinolone acetoinde intravitreal injection for macular edema secondary to central retinal vein occlusion[J]．Chin J Exp Ophthalmol， 2016，34(9)∶837-841. DOI： 10.3760/cma.j.issn.2095-0160.2016.09.013 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[25]
Shen L , You Y , Sun S ，et al. Intraocular and systemic pharmacokinetics of triamcinolone acetonide after a single 40-mg posterior subtenon application[J]．Ophthalmology， 2010，117(12)∶2365-2371. DOI： 10.1016/j.ophtha.2010.03.033 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Ehrlich R , Ciulla TA , Moss AM ，et al. Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion：6 months of follow-up[J]．Graefe's Arch Clin Exp Ophthalmol， 2010，248(3)∶375-380. DOI： 10.1007/s00417-009-1211-6 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Iwao K , Inatani M , Kawaji T ，et al. Frequency and risk factors for intraocular pressure elevation after posterior sub-Tenon capsule triamcinolone acetonide injection[J]．J Glaucoma， 2007，16(2)∶251-256. DOI： 10.1097/IJG.0b013e31802d696f .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Xu X , Han Y , Kong L ，et al. Clinical implication of triamcinolone in aqueous humor after depository sub-Tenon application[J]．J Cataract Refract Surg， 2017，43(11)∶1383-1390. DOI： 10.1016/j.jcrs.2017.08.010 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Mishra C , Lalitha P , Rameshkumar G ，et al. Incidence of endophthalmitis after intravitreal injections：risk factors，microbiology profile，and clinical outcomes[J]．Ocul Immunol Inflamm， 2018，26(4)∶559-568. DOI： 10.1080/09273948.2018.1430238 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
原丽，Email： mocdef.3ab614002.oaijgnehz
B

解瑞：设计试验、实施研究、采集/分析数据、文章撰写；原丽：数据统计、文章修改及定稿

C
所有作者均声明不存在利益冲突
D
山西省自然科学基金项目 (20210302124324)
山西省卫生健康委员会科研课题项目 (2019136、2020135)
山西省高等学校科技创新项目 (2017166)
长治医学院博士启动基金项目 (BS17001)
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
玻璃体腔注射雷珠单抗联合曲安奈德治疗视网膜静脉阻塞继发黄斑水肿对黄斑区视网膜微循环的影响
谢佩玲 等
中国药物与临床 2024,24(19)
3D打印Tenon囊下曲安奈德持续给药装置在兔眼房水中的药物代谢动力学研究
叶丽妍 等
中华眼外伤职业眼病杂志 2024,46(08)
视网膜分支静脉阻塞继发黄斑水肿患眼玻璃体腔注射康柏西普治疗后黄斑区微血管结构改变
杨治坤 等
中华眼底病杂志 2021,37(09)
后Tenon囊下注射曲安奈德治疗白内障手术后黄斑囊样水肿的短期疗效观察
黄颖 等
中华眼底病杂志 2020,36(08)
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大