预测视网膜静脉阻塞继发黄斑水肿抗VEGF治疗后视力的形态学指标分析

Morphologic predictors of visual outcome in patients with macular edema secondary to retinal vein occlusion treated with anti-VEGF therapy

目的评价视网膜静脉阻塞(RVO)继发黄斑水肿(ME)患者抗VEGF治疗基线荧光血管造影(FFA)及相干光断层扫描(OCT)指标与患者治疗后最佳矫正视力(BCVA)的关系。设计回顾性病例系列。研究对象北京同仁医院连续抗VEGF治疗应答良好的125例125眼RVO继发ME患者。方法所有患者均接受每月1次玻璃体注射雷珠单抗0.05 ml,直至ME完全消退。所有患者均采用Spectralis HRA+OCT进行FFA及OCT检查,半自动分析患者基线FFA及OCT形态学指标。采用Logtistic回归分析评价各分析因素与患者治疗后BCVA的关系。主要指标BCVA,黄斑旁中心凹毛细血管灌注,黄斑中心视网膜厚度,黄斑中心视网膜容积,视网膜各层的完整性。结果 125眼中,7眼(5.6%)基线BCVA≥0.5,抗VEGF治疗后43眼(34.4%)BCVA≥0.5。患者基线黄斑旁中心凹毛细血管无灌注(P=0.01,OR=0.213)、内丛状层结构模糊(P=0.005,OR=0.225)、外界膜破坏(P=0.001,OR=0.160)是阻碍治疗后获得良好视力预后的主要影响因素。结论基线FFA显示黄斑中心凹毛细血管无灌注或OCT显示黄斑中心凹区视网膜内丛状层结构模糊或外界膜破坏提示抗VEGF治疗RVO继发ME的视力预后不佳。

Objective To evaluate the associations between baseline fundus fluorescence angiography（ FFA） and optical coherent tomography（ OCT） characteristics and visual outcome of patients treated using anti-VEGF therapy for macular edema（ ME） secondary to retinal vein occlusion（ RVO）. Design Retrospective case series. Participants 125 Patients with ME second to RVO,who received intravitreal injection of ranibizumab（ IVR） and had good response in Beijing Tongren Hospital. Methods All the patients received monthly IVR till the ME resolved,and underwent routine FFA and OCT examination using Spetralis HRA-OCT. Baseline changes in FFA and OCT were semi-automatically analyzed. The binary logistic regression was used to analyze the relationship between morphologic changes and best corrected visual acuity（ BCVA） at final visit. Main Outcome Measures BCVA,parafoveal capillary perfusion,central retinal thickness,central retinal volume,the integrity of each retinal layers in OCT. Results Among 125 patients,the percentage of them with BCVA ≥0. 5 at baseline was 5. 6%（ 7/125）,while 34. 4%（ 43/125） at final visit. The parafoveal capillary non-perfusion in FFA（ P = 0. 01,OR = 0. 213）,obscure inner plexiform layer（ IPL）（ P = 0. 005,OR = 0. 225）,and external limiting membrane（ ELM） rupture in OCT（ P = 0. 001,OR = 0. 16） hindered patients from gaining good vision prognosis after treatment. Conclusion For patients with ME secondary to RVO,parafoveal capillary non-perfusion in FFA,obscure IPL,and ELM disruption in OCT might predict poor vision after anti-VEGF therapy.