| Objective:To make a comparison on the efficacy and safety in the treatment of macular edema caused by CRVO in young patients between intravitreal injection of ranibizumab combined with dexamethasone intravitreal implant and ranibizumab alone.Methods:The study adopts a retrospective case-control study.From October 2017 to July2019,42 young patients(42 eyes)diagnosed as ischemic or non-ischemic central retinal vein occlusion(CRVO)secondary macular edema by fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)in the Second Affiliated Hospital of Nanchang University were analyzed.The average age of these patients is30.50±5.92 years(ranging from 19 to 39 years),of which 79% is male while the remaining 21% is female.22 cases and 22 eyes in the combined group were treated with intravitreal injection of ranibizumab before being treated with intravitreal injection of dexamethasone one week later.20 cases and 20 eyes in the simple group were treated with intravitreal injection of ranibizumab alone.However,both two groups would repeat intravitreal injection when necessary.Both groups of patients with ischemic CRVO received pan retinal photocoagulation(PRP)to prevent neovascularization.The best corrected visual acuity(BCVA),macu lar fovea thickness,intraocular pressure,macular edema condition,injection times of ranibizumab,retinal perfusion status,along with ocular and systemic adverse events related to injection therapy,were observed during the period prior to treatment,1 week,1 month,2 months,3 months,6 months,9 months after intravitreal drug injection therapy in the two treatment groups.Functional success is defined as a visual gain of at least 0.1 Log MAR.Anatomical success is defined as using optical coherence tomography to scan macular fovea thickness <300 um.The follow-up period was 12 to 18 months,with an average of 14.21±2.22 months.Results:1.BCVA:The BCVA at each time point after treatment was significantly higher than that before treatment in both groups,and the difference was statistically significant,P<0.05.BCVA comparison between the two groups: there was no significant difference in BCVA comparison between the two groups at the first visit(P=0.980),and there was no significant difference in BCVA comparison between the two groups at 1 week,1 month,6 months,9 months and the last follow-up after treatment(P= 0.900,P=0.431,P=0.795,P=0.384,P=0.676).Besides,there was a significant difference in BCVA comparison between the two groups at 2m and 3m after treatment(P=0.043,P=0.044 respectively).More subjects in the combined group obtained visual gain above 0.6 Log MAR unit.2.CMT:The CMT at each time point after treatment decreased compared with that before treatment in both groups,with statistically significant difference,P<0.05.CMT comparison between the two groups: there was no significant difference in CMT comparison between the two groups at the first visit(P= 0.270).Moreover,there was no significant difference in CMT comparison between the two groups at 1week,1 m,6 m and the last follow-up after treatment(P= 0.355,P= 0.253,P=0.959,P=0.392).In addition,there was a significant difference in CMT comparison between the two groups at 2 m,3 m and 9 m after treatment(P=0.022,P=0.012,P=0.039respectively).During each follow-up period after treatment,patients who revealed macular edema regression came more from the combined group.3.IOP:Combined group: There was no significant difference in IOP at 1 week,3m,6m,9m and the last follow-up after treatment,compared with that before treatment(P=0.183,P=0.501,P=0.501,P=0.641,P=0.291),while there was a significant difference in IOP at 1m and 2m after treatment,compared with that before treatment(P= 0.040,P=0.047 respectively).Six eyes(27.2%)had elevated intraocular pressure at 0.5±0.39 months after treatment.Additionally,intraocular pressure could be controlled within the normal range by local application of anti-glaucoma drugs.No neovascular glaucoma occurred.Simple group: IOP changes at each follow-up time point after treatment were not statistically significant,compared with those before treatment,P>0.05.IOP comparison between the two groups: there was no significant difference in IOP comparison between the two groups at the first visit(P= 0.656).Furthermore,there was no significant difference in IOP comparison between the two groups at 3m,6m,9m and the last follow-up after treatment(P=0.308,P=0.859,P=0.370,P=0.644).There was a significant difference in IOP comparison between the two groups at 1week,1m and 2m after treatment(P=0.014,P=0.014,P=0.024 respectively).4.There was no significant difference in recurrence time of macular edema between the combined group and the simple group.(P =0.540).In the combined group,the injection times of ranibizumab,with an average of 2.6 times.By contrast,in the simple group,the injection times of ranibizumab,with an average of 4.8 times.The difference between the two groups was statistically significant(t=-5.93,P=0.000).5.The patients with ischemic CRVO in the combined group and the simple group have worse best corrected visual acuity than the patients with non-ischemic CRVO at the first visit and at the end of follow-up,with statistical significance(P=0.013,P=0.000,P= 0.033,P = 0.000,respectively);The BCVA at the end of follow-up for patients with non-ischemic CRVO in the combined group was statistically significant compared with BVCA at the end of follow-up for patients with non-ischemic CRVO in the simple group(P = 0.018).6.Adverse events: IOP increased in 6 eyes(27%)of the combined group;One patient developed posterior capsular opacification.Patients in the simple group had no elevated intraocular pressure.No serious side effects were observed in the two treatment groups throughout the study period.Conclusion:1.Intravitreal injection of ranibizumab combined with dexamethasone intravitreal implant is an effective method for the treatment of young CRVO patients,for the patients' vision has demonstrated significant improvement.Apart from that,CRVO-related macular edema rapidly subsides,which reduces the injection times of ranibizumab and meanwhile,relieves the financial burden.Thus,it is more effective than ranibizumab treatment alone.However,the side effects of dexamethasone must be taken into account.2.Retinal perfusion has an impact on the prognosis of patients.Since the effects of the two treatments are not permanent,some patients may need reinjection. |
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