方法：临床确诊为BRVO继发黄斑水肿的病例患者44例44眼纳入研究，分为玻璃体腔注射雷珠单抗+黄斑区激光光凝组(联合组)和单纯黄斑区激光光凝组(光凝组)。所有患者均行最佳矫正视力、裂隙灯检查、眼底检查、非接触眼压计检查、荧光素眼底血管造影及光相干断层扫描检查。联合组所有患者均行常规玻璃体腔注射雷珠单抗0.05mL/0.5mg。出现黄斑水肿时，按需进行雷珠单抗玻璃体腔注射。玻璃体腔注射雷珠单抗后1wk，给予黄斑区激光光凝治疗。所有患者均随访6mo。对比分析患眼治疗前后BCVA及CMT的变化情况以及有无并发症发生情况。

结果：联合组疗效明显，视网膜厚度降低明显，视力提高快，视力及CMT值均与治疗前比较差异有统计学意义(视力：t=5.781、7.496、7.341、7.836，均P=0.000； CMT：t=9.784、11.893、11.573、11.437，均P=0.000)。激光组激光治疗后1wk视力与治疗前比较差异无统计学意义(t=2.130，P=0.053)，治疗后4、12、24wk视力改善与治疗前比较差异均有统计学意义(t=3.524、6.429、6.922，P=0.04、0.000、0.000)。联合组与激光组治疗后1、4、12、24wk不同时间点视力比较差异有统计学意义(t=2.604、3.223、3.303、3.296，P=0.015、0.03、0.04、0.03)。联合组与激光组治疗后不同时间点CMT值变化差异有统计学意义(t=43.231、50.504、56.074、38.103，均P=0.000)。随访期间未发生眼部并发症及全身不良反应。

结论：雷珠单抗联合黄斑区激光光凝治疗BRVO继发黄斑水肿有良好的疗效及安全性。

METHODS:Forty-four patients(44 eyes)with macular edema secondary to BRVO were enrolled. Patients received intravitreal injection of ranibizumab(0.05mL/0.5mg)and laser photocoagulation(ranibizumab group)or laser photocoagulation alone(control group). Patients in ranibizumab group were given laser photocoagulation at 1mo after intravitreal injection. Then ranibizumab was given again if needed. The best corrected visual acuity(BCVA), slitlamp examination, fundus examination, non-contact tonometer examination and fundus fluorescein angiography were taken. All patients were followed up for 6mo. We analyzed the changes on BCVA,central macular thickness(CMT)before and 1,4,12 and 24wk after treatments, and related complications were recorded.

RESULTS:Outcomes are significantly better in ranibizumab group with reduced retinal thickness and improved visual acuity. In ranibizumab group, both visual acuity and CMT values were significantly better than those before treatments(visual acuity:t=5.781,7.496,7.341,7.836, all P=0.000; CMT:t=9.784,11.893,11.573,11.437, all P=0.000).In control group, the improvement on visual acuity was not significantly better than that before treatment at 1wk(t=2.130,P=0.053); while the improvement on visual acuity was significantly better at 4,12 and 24wk(t=3.524,6.429,6.922,P=0.04,0.000,0.000).The improvements on visual acuity after treatments in ranibizumab group were significantly better than those in control group at 1,4,12 and 24wk(t=2.604,3.223,3.303,3.296,P=0.015,0.03,0.04,0.03).CMT values after treatments in ranibizumab group were significantly better than those in contral group at 1,4,12 and 24wk(t=43.231,50.504,56.074,38.103,all P=0.000).No severe ocular and systematic side effect was found.

CONCLUSION:Intravitreal injection of ranibizumab combined with laser photocoagulation was effective and safe for macular edema secondary to BRVO.