Nishimura Tomoharu, Machida Shigeki, Tada Atsushi, Oshida Eiki, Muto Tetsuya
Department of Ophthalmology, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minamikoshiagya, Koshigaya, Saitama, 343-8555, Japan.
Doc Ophthalmol. 2020 Oct;141(2):127-136. doi: 10.1007/s10633-020-09757-0. Epub 2020 Feb 25.
To evaluate the 12-month effects of intravitral ranibizumab (IVR) injections on the physiology and morphology of the macula in eyes with a branch retinal vein occlusion with macular edema (BRVOME).
We studied 13 eyes of 13 patients with a BRVOME. All patients were initially treated with IVR injections at 3 consecutive monthly intervals, the initiation phase. Additional treatments were done according to the pro re nata (PRN) regimen. The physiology of the macula was assessed by the focal macular electroretinograms (fmERGs) and the best-corrected visual acuity (BCVA). The morphology of the macular area was determined by spectral-domain optical coherence tomography. The retina was assessed at the baseline, and at 3, 6, and 12 months after beginning the IVR injections. The fmERGs were elicited by a 15° circular stimulus, and also by 15° semicircular stimuli placed on the occluded or non-occluded side of the macula. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sums of the oscillatory potentials (ΣOPs) were measured. In addition, the implicit times of the a- and b-waves were measured.
The BCVA was improved significantly relative to the baseline after the initiation phase (P < 0.01), and it was maintained with the PRN regimen for the 12-month experimental period. The foveal thickness was also significantly decreased after the initiation phase (P < 0.005) but was then worse at 12 months during the maintenance phase (P < 0.05). The fmERGs on the occluded side were significantly reduced at the baseline, and the b-waves and ΣOPs amplitudes improved after the initiation phase. However, they decreased during the PRN period. On the non-occluded side, the amplitudes and implicit times of the a- and b-waves remained unchanged after the initiation phase, the PhNR and ΣOPs amplitudes significantly increased at 3 months compared to the baseline (PhNR, P < 0.005; ΣOPs, P < 0.005), which was maintained throughout the 12 month study period.
The deterioration of the macular function on the occluded side during the maintenance phase suggests that there is a progression of the disease process during the PRN period in eyes with BRVOME.
评估玻璃体内注射雷珠单抗（IVR）对视网膜分支静脉阻塞合并黄斑水肿（BRVOME）患者黄斑区生理和形态的12个月影响。
我们研究了13例BRVOME患者的13只眼。所有患者在初始阶段连续3个月每月接受一次IVR注射。后续治疗根据按需（PRN）方案进行。通过黄斑局部视网膜电图（fmERGs）和最佳矫正视力（BCVA）评估黄斑区的生理状况。通过光谱域光学相干断层扫描确定黄斑区的形态。在基线时以及开始IVR注射后的3、6和12个月对视网膜进行评估。fmERGs由15°圆形刺激诱发，也由置于黄斑阻塞或未阻塞侧的15°半圆形刺激诱发。测量a波和b波的振幅、明视负反应（PhNR）以及振荡电位总和（ΣOPs）。此外，测量a波和b波的潜伏时间。
初始阶段后BCVA相对于基线有显著改善（P < 0.01），并且在12个月的实验期内通过PRN方案得以维持。初始阶段后黄斑中心凹厚度也显著降低（P < 0.005），但在维持阶段的12个月时变差（P < 0.05）。阻塞侧的fmERGs在基线时显著降低，初始阶段后b波和ΣOPs振幅有所改善。然而，在PRN期间它们下降。在未阻塞侧，初始阶段后a波和b波的振幅和潜伏时间保持不变，与基线相比，3个月时PhNR和ΣOPs振幅显著增加（PhNR，P < 0.005；ΣOPs，P < 0.005），在整个12个月的研究期内保持不变。
维持阶段阻塞侧黄斑功能的恶化表明，BRVOME患者在PRN期间疾病进程有所进展。
