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地塞米松和雷珠单抗治疗视网膜分支或中央静脉阻塞六个月的真实临床数据。

Real-life clinical data for dexamethasone and ranibizumab in the treatment of branch or central retinal vein occlusion over a period of six months.

作者信息

Winterhalter Sibylle, Eckert Annabelle, Vom Brocke Gerrit-Alexander, Schneider Alice, Pohlmann Dominika, Pilger Daniel, Joussen Antonia M, Rehak Matus, Grittner Ulrike

机构信息

Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.

Ophthalmicus Augentagesklinik, Villingen-Schwenningen, Germany.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2018 Feb;256(2):267-279. doi: 10.1007/s00417-017-3852-1. Epub 2017 Nov 28.

Abstract

PURPOSE

To evaluate the therapeutic outcome for dexamethasone implant (DEX) or intravitreal ranibizumab (IVR) injections over 6 months in patients with macular edema due to branch or central retinal vein occlusion (BRVO, CRVO), in a real-life setting.

METHODS

A total of 107 patients with BRVO or CRVO were included into this retrospective single-center observational study. Patients were treated with monotherapy consisting of DEX or three monthly IVR injections following a pro re nata regimen (PRN). Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were compared between the two therapy groups after 1, 3 and 6 months.

RESULTS

BRVO patients treated with DEX achieved a statistically significant gain in BCVA measured in logMAR after 1 month (mean gain, 95% CI: 0.21, 0.08-0.34, p = 0.001), 3 months (0.16, 0.03-0.28, p = 0.012) and 6 months (0.19, 0.07-0.32, p = 0.002), whereas patients treated with IVR showed a statistically significant BCVA gain in month 3 (mean improvement, 95% CI: 0.13, 0.01-0.26, p = 0.039) and month 6 (0.16, 0.03-0.29, p = 0.018). BCVA in CRVO patients with DEX worsened slightly at month 6 (mean worsening, 95% CI: -0.08, -0.24 to 0.08, p = 0.305), while IVR treated-patients achieved a statistically significant BCVA gain at 3 months (mean improvement, 95% CI: 0.14, 0.02-0.25, p = 0.021). Both therapies were accompanied by statistically significant CRT reductions of 150 to 200 μm (median). Adverse events reported were predictable and limited.

CONCLUSIONS

In a clinical setting, comparable improvement in BCVA and CRT were observed after DEX and IVR injections for treatment of BRVO. CRVO patients showed greater benefit with IVR.

摘要

目的

在实际临床环境中,评估地塞米松植入物(DEX)或玻璃体内注射雷珠单抗(IVR)治疗视网膜分支或中央静脉阻塞(BRVO、CRVO)所致黄斑水肿6个月的治疗效果。

方法

本回顾性单中心观察性研究共纳入107例BRVO或CRVO患者。患者接受DEX单药治疗或按照按需治疗方案(PRN)每3个月注射一次IVR。比较两组治疗1、3和6个月后的最佳矫正视力(BCVA)、视网膜中央厚度(CRT)和眼压(IOP)。

结果

接受DEX治疗的BRVO患者在1个月(平均改善,95%CI:0.21,0.08 - 0.34,p = 0.001)、3个月(0.16,0.03 - 0.28,p = 0.012)和6个月(0.19,0.07 - 0.32,p = 0.002)时,以logMAR测量的BCVA有统计学显著提高,而接受IVR治疗的患者在第3个月(平均改善,95%CI:0.13,0.01 - 0.26,p = 0.039)和第6个月(0.16,0.03 - 0.29,p = 0.018)时BCVA有统计学显著提高。接受DEX治疗的CRVO患者在6个月时BCVA略有下降(平均下降,95%CI: - 0.08, - 0.24至0.08,p = 0.305),而接受IVR治疗的患者在3个月时BCVA有统计学显著提高(平均改善,95%CI:0.14,0.02 - 0.25,p = 0.021)。两种治疗均伴有CRT统计学显著降低150至200μm(中位数)。报告的不良事件可预测且有限。

结论

在临床环境中,DEX和IVR注射治疗BRVO后,BCVA和CRT有相似改善。CRVO患者接受IVR治疗获益更大。

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