目的：研究地塞米松玻璃体内植入剂(Ozurdex)治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)的临床疗效、并发症及对视功能相关生存质量的影响。方法：选取2018-02/2019-02我院收治的RVO-ME初治患者30例30眼，其中视网膜中央静脉阻塞(CRVO)13眼，视网膜分支静脉阻塞(BRVO)17眼，均接受玻璃体腔注射Ozurdex治疗，随访6mo。对比分析患者治疗前，治疗后1wk，1、2、3、4、5、6mo后患者最佳矫正视力(BCVA)、眼压(IOP)、黄斑中心凹视网膜厚度(CMT)，以及治疗3mo后视觉相关生存质量表(CVRQoL-25)的评分变化，观察药物疗效、不良反应和评估患者视觉相关生存质量。结果：不同时间点BCVA、CMT、IOP均有差异(P<0.001)。与治疗前相比，所有患眼治疗后各时间点的BCVA均较治疗前提高，CMT均较治疗前下降(P<0.001)。与治疗前相比，治疗后2mo时BCVA、CMT变化最大(P<0.001)。治疗3mo后CVRQoL-25总分均值较治疗前提高，此时BCVA较治疗前提高，CMT较治疗前降低(P<0.01)。CVRQoL-25评分与患者治疗前和治疗3mo后BCVA(LogMAR)均呈负相关(rs=-0.717、-0.746，均P<0.001)； CVRQoL-25评分与治疗3mo后CMT呈负相关性(rs=-0.862，P=0.001)。黄斑水肿复发19眼(63%)，复发时间为1～3(平均2.8±0.5)mo，6mo内平均注射次数约2.3±0.4次。患者注射1wk、1、2、3mo后眼压均较注射前升高(P<0.05)。所有患者注射2mo后的眼压达到平均眼压峰值，较注射前平均增高7.85±0.32mmHg(P<0.05)，4mo后眼压可逐渐降至正常。随访期间有3眼(10%)出现眼压增高，超过25mmHg，通过局部用药即可控制，无需手术治疗。4眼(13%)出现白内障，其中2眼需要手术治疗。结论：Ozurdex在短期内可有效提高RVO-ME患者视力，降低黄斑中心凹厚度，同时可明显改善患者视功能相关生存质量。单次玻璃体腔植入Ozurdex可获得持续2～3mo的视力改善，63%患眼在注射后约3mo时ME复发，眼压增高和白内障仍是其主要的不良反应。

AIM: To study the clinical efficacy, complications and visual related quality of life(VRQoL)of Ozurdex in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME). METHODS: Totally 30 patients with ME, which had developed secondary to either CRVO(13 eyes)or BRVO(17 eyes), were monitored for 6mo after treatment with Ozurdex in the Department of Ophthalmology of our Hospital. We measured the best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT)at different time after treatment(1wk, 1mo, 2mo, 3mo, 4mo, 5mo, and 6mo after treatment), and we also measured the Chinese version vision related quality of life questionnaire-25(CVRQoL-25)at 3mo after treatment and compared them separately with the ones measured before treatment to evaluate the efficacy, adverse reactions and the visual related quality of life. RESULTS: Generalized estimation equation results showed that BCVA, CMT and IOP all had differences at different time points(P<0.001). A BCVA increase was achieved and CMT decreased in all patients at any time point after the onset of treatment(P<0.001). The changes of BCVA and CMT were the largest in the 2mo compared to the baseline(P<0.001). The score of CVRQol-25 at 3mo after treatment was significantly higher than that before treatment and then the central retinal thickness decreased and a BCVA increased compared to the baseline level(P<0.01). The score of CVRQoL-25 at 3mo was negatively correlated both with the LogMAR BCVA evaluated before treatment and at 3mo after treatment(rs= -0.717, -0.746, all P<0.001); Meanwhile, the score of CVRQoL-25 was also negatively correlated with CMT at 3mo after treatment(rs= -0.862, P=0.001). In 19 eyes(63%)of the patients with RVO-ME,a relapse was observed after a follow-up time of 1-3mo and the average recurrence time was(2.8±0.5)mo. In follow-up of 6mo, about(2.3±0.4)intravitreal Ozurdex injections per eye was observed. The increase in IOP was observed at 1wk, 1, 2, 3mo after pretherapy(P<0.05). The mean IOP values reached a peak at 2mo after injection, which rose(7.85±0.32)mmHg above the baseline level(P<0.05)and decreased to normal at 4mo after treatment. 10% of patients had an elevation in IOP above 25mmHg, which could be medically controlled and 4 eyes(13%)of patients had cataract formation, two of which needed to surgery. CONCLUSION: Ozurdex proved to be efficacious with increase in visual acuity and reduction of central retinal thickness and improve the visual function-related quality of life of RVO-ME patients. After single injection of Ozurdex, visual acuity benefited for 2-3mo. 63% of the patients relapsed at about 3mo after treatment. Adverse reactions associated to the use of Ozurdex include the formation of cataracts and an increase in IOP.

广西医疗卫生厅科研项目(No.S2018093, Z20180945)