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的meta分析

Efficacy of Intravitreal Ranibizumab Combined with Triamcinolone Acetonide for Macular Edema Secondary to Retinal Vein Occlusion: A Meta-analysis

关键词:  雷珠单抗  曲安奈德  视网膜静脉阻塞  黄斑水肿  Meta分析

Key words:  ranibizumab  triamcinolone acetonide  retinal vein occlusion  macular edema  Meta-analysis

摘要:

目的 评价玻璃体腔注射雷珠单抗联合曲安奈德（IVR+IVT）与单用雷珠单抗（IVR）治疗视网膜静脉阻塞继发黄斑水肿的疗效和安全性差异。方法 检索数据库资源，包括PubMed、Embase、Cochrane图书馆、中国知网（CNKI）、维普中文科技期刊数据库（VIP）和万方数据，收集建库至2019年1月治疗方案为IVR+IVT与IVR治疗视网膜静脉阻塞继发黄斑水肿的随机对照临床研究文献，纳入符合标准的文献，评价其质量，提取相关数据，采用RevMan 5.3统计软件进行Meta分析。结果 本研究共纳入4项RCTs文献，病例数215例，217眼。Meta分析结果提示，IVR+IVT组患者随访3个月时黄斑中心凹视网膜厚度（CMT）优于IVR组，差异有统计学意义，随访1，2，4，5，6个月2组间CMT差异无统计学意义；4项研究最佳矫正视力（BCVA）治疗后较治疗前提高，其中2项研究随访1个月时差异有统计学意义，随访2，3，4，5，6个月差异无统计学意义；在不良反应发生率方面，IVR+IVT组眼压升高并发症风险明显高于IVR组；2组在发生皮质性白内障方面，差异无统计学意义；在注射次数上，IVR+IVT组较IVR组明显减少，差异有统计学意义。结论 IVR+IVT与IVR治疗视网膜静脉阻塞继发黄斑水肿均有效，在随访3个月降低CMT和随访1个月改善BCVA方面存在统计学差异。IVR+IVT治疗虽增加眼压升高风险，但注射次数较IVR减少，同时也减轻患者经济负担。临床医师可根据实际情况，酌情选取合适治疗手段。

Abstract:

OBJECTIVE To evaluate the efficacy and safety of intravitreal injection of ranibizumab combined with triamcinolone acetonide(IVR+IVT) versus ranibizumab(IVR) in the treatment of macular edema secondary to retinal vein occlusion(RVO). METHODS PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang database were searched from building the library to January 2019 for randomized controlled trials on the treatment of RVO with IVR+IVT versus IVR. Then, the Cochrane RCTs score scale was used to evaluate the relevant data and the quality of the research literature, and the Cochrane Collaboration's software RevMan 5.3 was used to analyze. RESULTS Four RCTs were included with 215 cases and 217 eyes. Meta-analysis results indicated that the center macular thickness(CMT) in IVR+IVT patients in 3 month follow-up showed better than that in IVR patients, which was no statistical difference between 2 groups in 1, 2, 4, 5, 6 months. The best corrected visual acuity(BCVA) was improved in 4 studies compared with before treatment. In 2 cases, there were significant differences in 1 month, but no significant difference was found in 2, 3, 4, 5 and 6 months. In terms of the incidence of adverse reactions, IVR+IVT group's intraocular hypertension was significantly higher than that in the IVR group, but there was no significant difference in the occurrence of cortical cataract between the 2 groups. IVR+IVT group was significantly less than the IVR group in the number of injections, and the difference was statistically significant. CONCLUSION IVR+IVT and IVR are effective in the treatment of RVO, but there is a difference in the reduction of CMT in 3 month follow-up and the improvement of BCVA in 1 month follow-up. Although IVR+IVT may increase the adverse reaction of intraocular pressure elevation, it can also reduce the injection times and the burden of patients. Clinicians can select appropriate treatment methods according to the actual situation.