Noma Hidetaka, Yasuda Kanako, Nonaka Ryota, Sasaki Shotaro, Shimura Masahiko
Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan.
Clin Ophthalmol. 2023 Aug 9;17:2267-2275. doi: 10.2147/OPTH.S418843. eCollection 2023.
In branch retinal vein occlusion (BRVO), administering steroid injections to inhibit expression of inflammatory factors in the first phase of macular edema may reduce recurrence of the edema. The purpose of our study was to investigate the functional and morphological prognosis and frequency of recurrence after injection of an anti-vascular endothelial growth factor (VEGF) with and without initial steroid therapy to treat macular edema with BRVO.
Patients with BRVO and macular edema (41 eyes) received intravitreal ranibizumab injection (IRI) alone (IRI group, 21 eyes) or subtenon triamcinolone (STTA) injection and IRI (combination group, 20 eyes). Patients in both groups with recurrent macular edema received further IRI as appropriate. A laser flare meter was used to assess aqueous flare values, and an optical coherence tomography device was used to measure central macular thickness (CMT). Before the first treatment, we obtained samples of aqueous humor and analyzed them by the suspension array method to evaluate VEGF, placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, soluble intercellular adhesion molecule (sICAM)-1, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, and interferon-inducible 10-kDa protein (IP-10).
The two groups were not significantly different with regard to levels of VEGF, PlGF, PDGF-AA, sICAM-1, MCP-1, IL-6, IL-8, or IP-10. Best-corrected visual acuity, CMT, and aqueous flare value (IRI group, baseline 8.69 ± 4.55 photon counts/ms; combination group, baseline 9.21 ± 3.72 photon counts/ms) improved significantly in both groups without significant intergroup differences. Analyses showed no significant intergroup differences in the mean number of IRIs during the 12-month follow-up, but the proportion of patients without recurrence (ie, who received only one IRI) was significantly higher in the combination group than in the IRI group (P = 0.032). Furthermore, the time to initial recurrence was significantly longer in the combination group than in the IRI group (P = 0.003).
These findings suggest that initial STTA injection and IRI may have a synergistic effect in patients with BRVO and macular edema in that they increase the time between anti-VEGF treatments.
在视网膜分支静脉阻塞（BRVO）中，在黄斑水肿的第一阶段注射类固醇以抑制炎症因子的表达可能会减少水肿的复发。我们研究的目的是调查在治疗BRVO相关性黄斑水肿时，注射抗血管内皮生长因子（VEGF）联合或不联合初始类固醇治疗后的功能和形态学预后以及复发频率。
BRVO相关性黄斑水肿患者（41只眼）单独接受玻璃体内注射雷珠单抗（IRI组，21只眼）或球周注射曲安奈德（STTA）后再行IRI（联合组，20只眼）。两组中复发性黄斑水肿患者均酌情接受进一步的IRI治疗。使用激光flare仪评估房水flare值，使用光学相干断层扫描设备测量中心黄斑厚度（CMT）。在首次治疗前，我们采集房水样本并通过悬浮阵列法进行分析，以评估VEGF、胎盘生长因子（PlGF）、血小板衍生生长因子（PDGF）-AA、可溶性细胞间黏附分子（sICAM）-1、单核细胞趋化蛋白1（MCP-1）、白细胞介素（IL）-6、IL-8和干扰素诱导的10 kDa蛋白（IP-10）。
两组在VEGF、PlGF、PDGF-AA、sICAM-1、MCP-1、IL-6、IL-8或IP-10水平上无显著差异。两组的最佳矫正视力、CMT和房水flare值（IRI组，基线8.69±4.55光子计数/毫秒；联合组，基线9.21±3.72光子计数/毫秒）均显著改善，组间无显著差异。分析显示，在12个月的随访期间，两组间IRI的平均次数无显著差异，但联合组中无复发（即仅接受一次IRI）的患者比例显著高于IRI组（P = 0.032）。此外，联合组首次复发的时间显著长于IRI组（P = 0.003）。
这些发现表明，初始STTA注射和IRI对BRVO相关性黄斑水肿患者可能具有协同作用，因为它们延长了抗VEGF治疗之间的时间间隔。
