视网膜分支静脉阻塞继发黄斑水肿玻璃体腔注射康柏西普联合视网膜激光光凝治疗后中心凹视网膜厚度对远期视力预后的影响

The effect of retinal thickness on the prognosis of long-term vision after the treatment of intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema secondary to branch retinal vein occlusion

目的 观察视网膜分支静脉阻塞（BRVO）继发黄斑水肿（ME）玻璃体腔注射康柏西普联合视网膜激光光凝治疗后黄斑中心凹视网膜厚度（CMT）对远期视力预后的影响.方法 回顾性病例分析.临床检查确诊的缺血型BRVO继发ME患者41例41只眼纳入研究.其中,男性23例23只跟,女性18例18只眼.平均年龄（56.49±8.94）岁.均行最佳矫正视力（BCVA）、光相干断层扫描检查.BCVA统计时换算为最小分辨角对数（logMAR）视力.患眼平均logMAR BCVA为0.82±0.41;平均CMT为（512.61±185.32） μm.依据治疗后1个月时CMT降低值将患眼分为无应答组、应答组,分别为15例15只眼、26例26只眼.两组患者年龄、性别构成比较,差异无统计学意义（t=-0.298、-1.708,P=0.767、0.096）;注药次数比较,差异有统计学意义（t=3.589,P=0.010）;患眼平均logMAR BCVA、CMT比较,差异无统计学意义（t=2.056、-1.876,P=0.460、0.070）.平均随访时间8个月.将随访时间≥6个月时的logMARBCVA定义为远期视力.观察两组患眼治疗后1、6个月CMT和远期视力变化.Pearson相关性分析远期视力与年龄、治疗前logMARBCVA、治疗前CMT、注药次数、治疗后1个月CMT降低值的相关性.多元回归分析远期视力与年龄、性别、治疗前logMAR BCVA、治疗前CMT、注药次数、治疗后1个月CMT降低值、椭圆体带完整性、外界膜（ELM）完整性的相关性.结果 治疗后1个月,患眼CMT较治疗前降低（231.48±177.99） μm;ELM、椭圆体带平均完整性分别为0.56±0.50、0.41±0.50.治疗后6个月,患眼平均logMAR BVCA为0.48±0.34.Pearson相关性分析结果显示,远期视力与治疗前logMARBCVA以及治疗后1个月CMT降低值、注药次数呈正相关（P＜0.05）;与年龄、治疗前CMT无相关（P＞0.05）.多元回归分析结果显示,远期视力与治疗前logMAR BVCA、治疗后1个月CMT降低值、ELM完整性、注药次数相关（P＜0.05）;与年龄、性别、治疗前CMT、椭圆体带完整性无相关（P＞0.05）.治疗后6个月,无应答组、应答组患眼logMAR BCVA分别为0.86±0.23、0.26±0.14;平均CMT分别为（398.93±104.87）、（255.15±55.18） μm;平均注药次数分别为（2.53±1.46）、（1.31±0.74）次.两组患眼平均logMARBCVA、CMT、注药次数比较,差异均有统计学意义（t=10.293、5.773、3.589,P=0.000、0.000、0.001）.所有患者均未出现与药物、玻璃体腔注射相关的并发症.结论 缺血型BRVO继发ME玻璃体腔注射康柏西普联合视网膜激光光凝治疗后远期视力与治疗后1个月CMT降低值、外界膜完整性相关;与治疗前CMT、椭圆体带完整性无相关.

Objective To observe the effect of macular retinal thickness （CMT） on the long-term visual prognosis after intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema （ME） secondary to branch retinal vein occlusion （BRVO）.Methods A retrospective non randomized controlled study.Forty-one patients （41 eyes） of ischemic BRVO secondary ME were included in the study.Among them,there were 23 males （23 eyes） and 18 females （18 eyes）.The average age was （56.49±8.94） years.The best corrected visual acuity （BCVA） and optical coherence tomography were performed.The mean logMAR BCVA was 0.82±0.41,and the mean CMT was （512.61 ± 185.32） μrn.According to the CMT reduction value at 1 month after treatment,the eyes were divided into no response group and response group,each has 15 patients of 15 eyes and 26 patients of 26 eyes respectively.The age and sex composition of the two groups were not statistically significant （t=-0.298,-1.708;P=0.767,0.096）,and the difference of frequency of injection was statistically significant （t=3.589,P=0.010）,and there was no statistical difference between the patients with logMAR BCVA and CMT （t=2.056,-1.876;P=0.460,0.070）.The average follow-up was 8 months.The logMAR BCVA on 6 months after treatment was defined as long term vision.The changes of long term vision and CMT on 1 and 6 months of two groups after treatment were observed.Pearson correlation analysis showed that the correlation between long-term vision and age,logMAR BCVA before treatment,CMT before treatment,frequency of injection,and CMT value decreased 1 month after treatment.The correlation of long-term visual acuity with age,sex,logMAR BCVA before treatment,CMT before treatment,number of drugs before treatment,CMT reduction at 1 month after treatment,integrity of ellipsoid band and integrity of external membrane （ELM） were analyzed by multiple regression analysis.Results On 1 month after treatment,the CMT of the eyes was lower than that before treatment （231.48± 177.99） μm,and the average integrity of ELM and ellipsoid were 0.56±0.50 and 0.41 ±0.50 respectively.On 6 months after treatment,the average logMAR BVCA of the eyes was 0.48 ± 0.34.The results of Pearson correlation analysis showed that the long-term vision was positively correlated with the logMAR BCVA before treatment and the number of CMT reduction and the number of drug injection at 1 month after treatment （P〈0.05）;there was no correlation with age and CMT before treatment （P〉0.05）.The results of multiple regression analysis showed that the long-term vision was associated with logMAR BVCA before treatment,CMT reduction,ELM integrity,and the number of times of injection （P〈0.05）,and no correlation with age,sex,CMT before treatment and the integrity of the ellipsoid （P〉0.05）.On the 6 months after treatment,the logMAR BCVA in the non-response group and the response group were 0.86±0.23 and 0.26±0.14,and the average CMT was respectively （398.93±104.87） and （255.15 ± 55.18） μrn,and the average injection times were respectively （2.53 ± 1.46） and （1.31 ± 0.74） times.The average logMAR BCVA,CMT and injection times of the two groups were statistically significant （t=10.293,5.773,3.589;P=0.000,0.000,0.001）.No complications related to drug or intravitreal injection occurred in all patients.Conclusion The long-term vision of ME secondary to BRVO after intravitreal injection of Conbercept combined with retinal laser photocoagulation was associated with the decrease of CMT and the integrity of the ELM after 1 month of treatment,no correlation was found between CMT and ellipsoid integrity before treatment.