贝伐单抗治疗视网膜中央静脉阻塞黄斑水肿后视力恢复的预测因素分析

Prognostic Factors for Visual Outcome after Intravitreal Bevacizumab for Macular Edema Due to Central Retinal Vein Occlusion

【目的】分析38例经玻璃体腔注射贝伐单抗治疗的视网膜中央静脉阻塞黄斑水肿(CRVO-ME)患者的临床特征,评估并筛选对患者最终视力恢复有预测意义的因素。【方法】38例CRVO-ME患者,采用玻璃体腔注射25 g/L的贝伐单抗0.05 mL,必要时重复治疗,随访12个月。根据12月时视力恢复水平,将患者分为两组:W组(24例)为视力恢复良好组(Well-gainer);P组(14例)为视力恢复不良组(Poor-gainer)。分析两组患者的年龄、病程、基线视力、光学相干断层扫描特征(OCT)和荧光血管造影(FFA)特征。【结果】P组患者治疗前存在黄斑缺血者比W组多见(W组:11/24,45.8%;P组:11/14,78.6%;P=0.049)。W组患者平均年龄比P组患者小(W组:51.21±11.69;P组:57.50±6.76;P=0.043),治疗前最佳矫正视力(BCVA)差(W组:1.40±0.59;P组:1.03±0.46;P=0.041),首次注射后1月视力提高大于4行Snellen视力表的患者比率高(W组:83.3%,20/24;P组:14.3%,2/14;P<0.001)。首次注射后1月视力提高与最终视力呈正相关(r=0.624,P<0.001)。中央黄斑厚度下降程度与视力改善程度之间无相关性(r=0.269,P=0.193)。【结论】年龄、基线最佳矫正视力、黄斑缺血等因素可能是影响最终视力恢复的有意义的预测因子。治疗前视力较低的年轻患者最终视力恢复较理想,治疗前即已有黄斑缺血的患者往往最终视力恢复欠佳。首次注射后1月时视力恢复程度对最终视力有预测价值。对CRVO-ME患者行抗血管内皮生长因子(VEGF)治疗,需慎重评估,做好解释沟通工作,讲明重复治疗的可能和最终的视力预后。

[Objective]To evaluate predictive factors for final visual outcomes after intravitreal bevacizumab injections in 38 patients with macular edema secondary to CRVO. [Method] Thirty-eight patients with ME due to CRVO and treated with intravitreal 0.05 mL 25g/L bevacizumab on an as-needed basis with follow-up of 12 months were reviewed. Patients were divided into two groups according to the final visual gain ： Group W （ ＂well-gainer＂ ） and Group P （ ＂Poor-gainer＂ ）. Group W and Group P contains 24 and 14 patients respectively. Comparative demographic, duration, baseline VA, OCT and FFA characteristics between the two groups were analyzed. [Result] Macular ischemia at baseline was more frequent in Group P than Group W （Group W： 45.8%, 11/24; Group P： 78.6%, 11/14; P = 0.049）. ＂Well-gainers＂ in Group W were younger （Group W： 51.21 ± 11.69; Group P： 57.50 ± 6.76; P = 0.043） and had a relatively lower baseline VA than ＂Poor-gainers＂ in Group P （Group W： 1.40 ± 0.59; Group P： 1.03 ±0.46; P = 0.041 ）. There were more ＂early gainers＂, whose BCVA improved 4 lines of Snellen after the initial bevacizumab therapy, in Group W （Group W： 83.3%, 20/24; Group P： 14.3%, 2/14; P 〈 0.001）. VA gain 1 month after initial injection was significantly associated with a better final VA improvement （r = 0.624,P 〈 0.001 ）. No correlations were observed between CMT resolution and final VA