目的：探讨玻璃体腔注射雷珠单抗治疗非感染性葡萄膜炎黄斑水肿的临床疗效及安全性。

方法：前瞻性、无对照、开放性研究。经荧光素眼底血管造影(FFA)及光学相干断层扫描(OCT)确诊的非感染性葡萄膜炎黄斑水肿患者17例17眼纳入本研究。采用糖尿病视网膜病变早期治疗研究视力表检查最佳矫正视力(BCVA)，光相干断层扫描(OCT)测量黄斑中心凹视网膜厚度(CMT)。所有患眼玻璃体腔注射雷珠单抗0.05mL(0.5mg)1次。对比分析治疗前，治疗后2、4、8、12wk患眼BCVA、CMT、眼压变化情况及眼部相关不良反应。

结果：患眼治疗前BCVA中位数为57(百分位数P₂₅、P₇₅分别为52.5、64.5)个字母，CMT中位数为524(百分位数P₂₅、P₇₅分别为365.5、571)μm。治疗后2、4、8、12wk，患眼BCVA中位数分别为76(百分位数P₂₅、P₇₅分别为71、80)、81(百分位数P₂₅、P₇₅分别为78.5、83)、82(百分位数P₂₅、P₇₅分别为68.5、84)、82(百分位数P₂₅、P₇₅分别为78.5、83)个字母。Friedman M检验结果显示四组不同随访时间的BCVA字母数有差别(χ²=47.58，P<0.01)，即玻璃体腔注射药物治疗后BCVA字母数高于治疗前。治疗后2、4、8、12wk，患眼CMT中位数分别为307(百分位数P₂₅、P₇₅分别为249.5、374.5)、231(百分位数P₂₅、P₇₅分别为212.5、267)、219(百分位数P₂₅、P₇₅分别为210.5、365.5)、217(百分位数P₂₅、P₇₅分别为201.5、366.5)μm。Friedman M检验结果显示四组不同随访时间的CMT有差别(χ²=40.33，P<0.01)，即玻璃体腔注射药物治疗后CMT低于治疗前。术后12wk可见17眼中有6眼(35%)BVCA字母数降低，CMT增加，眼内炎症加重，增加激素剂量眼内炎症可控制。术中及术后未出现相关并发症。

结论：短期内玻璃体腔注射雷珠单抗可以作为治疗非感染性葡萄膜炎黄斑水肿的辅助治疗手段，可以降低黄斑水肿，提高视力，安全有效。

METHODS: This was an open and prospective study without control trial. Seventeen eyes from 17 patients with UME diagnosed by fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were enrolled in this study. Before the injection, best-corrected visual acuity(BCVA)of early treatment of diabetic retinopathy study(ETDRS)and central macular thickness(CMT)measured by OCT were examined. All affected eyes were treated with intravitreal ranibizumab 0.05mL(0.5mg). The BCVA, CMT and intraocular pressure(IOP)were compared with baseline at 2, 4, 8 and 12wk after treatment. Related complications were recorded.

RESULTS: The median BCVA before treatment was 57(P₂₅ and P₇₅ were 52.5 and 64.5, respectively). The median CMT was 524μm(P₂₅ and P₇₅ were 365.5 and 571, respectively). At 2, 4, 8, and 12wk after injection, the median BCVA of the affected eyes was 76(P₂₅ and P₇₅ were 71 and 80, respectively), 81(P₂₅ and P₇₅ were 78.5 and 83, respectively), 82(P₂₅ and P₇₅ were 68.5 and 84, respectively), and 82(P₂₅ and P₇₅ are 78.5 and 83, respectively). The Friedman M test showed that there were differences in the BCVA in the four groups at different follow-up times, that was, BCVA after injection was higher than before injection(χ²=47.58, P<0.01). At 2, 4, 8, and 12wk after injection, the median CMT was 307μm(P₂₅ and P₇₅ were 249.5 and 374.5, respectively),231μm(P₂₅ and P₇₅ were 212.5 and 267), 219μm(P₂₅ and P₇₅ were 210.5 and 365.5,respectively), and 217μm(P₂₅ and P₇₅ were 201.5 and 366.5,respectively). The Friedman M test showed that there was difference in the CMT in the four groups at different follow-up times(χ²=40.33, P<0.01), that was, CMT after injection was lower than before injection. At the 12wk after injection, increased CMT and decreased BCVA were found in 35% of study eyes(6/17)that had uncontrolled intraocular inflammation, and all these patients needed to increase prednisone again. No adverse events were found during the follow-up duration.

CONCLUSION: Intravitreal ranibizumab is a safe and effective approach for noninfectious uveitic macular edema in the short term, which can significantly improve visual acuity and reduce CMT in patients refractory to or intolerant of standard corticosteroid/ immunomodulatory therapy.