抗VEGF治疗视网膜静脉阻塞伴黄斑水肿患者疗效及预后影响因素

Efficacy and Prognostic Factors of Anti-vegf in the Treatment of Retinal Vein Occlusion with Macular Edema

目的观察视网膜静脉阻塞伴黄斑水肿患者应用抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗的临床效果并分析抗VEGF治疗对预后效果影响。方法选取2017年9月至2019年9月玉溪市人民医院眼科收治的129例视网膜静脉阻塞伴黄斑水肿患者为研究对象。按照随机数字表法分为研究组与常规组。常规组(n=65例)采用视网膜激光光凝治疗;研究组(n=64例)在常规组基础上结合抗VEGF治疗,对比两组最佳矫正视力(BCVA)、眼压(IOP)、黄斑中心凹厚度(CMT)、不良反应情况。根据治疗后CMT情况对抗VEGF治疗患者进行分组,分为<300μm组以及>300μm组,收集患者临床基线资料(年龄、性别、病程)及基线CMT进行单因素分析以及多因素回归分析,分析视网膜静脉阻塞伴黄斑水肿患者预后(黄斑中心视网膜厚度)影响因素。结果研究组和常规组的BCVA较治疗前均明显提高,CMT较治疗前均明显缩小,眼压降低(P<0.05);治疗12周后,研究组BCVA高于常规组,CMT小于常规组,眼压低于常规组(P<0.05)。治疗24周后研究组总有效率高于常规组(P<0.05);治疗期间,患者均未出现不良反应。结论病程以及基线CMT是治疗3个月后影响黄斑中心视网膜厚度的独立因素。抗VEGF药物在视网膜静脉阻塞黄斑水肿治疗中疗效显著,安全性较高,各因素中基线CMT、病程因素可作为临床医生对RVO伴ME患者预后情况的良好预测因素。

Objective To observe the clinical effect of anti-vegf treatment in patients with retinal vein occlusion and macular edema and to analyze the effect of anti-vegf treatment on the prognosis. Methods A total of129 patients with retinal vein occlusion and macular edema admitted to the Department of Ophthalmology of People’s Hospital of Yuxi from September 2017 to September 2019 were selected as research subjects. According to the random number table method, they were divided into the experimental group and the control group. The control group(n = 65 cases) was treated with retinal laser photocoagulation, and the experimental group(n = 64 cases) was treated with anti-vegf on the basis of the control group. The two groups were compared for the best corrected visual acuity(BCVA), intraocular pressure(IOP), macular fovea thickness(CMT) and adverse reactions. According to the CMT after treatment, patients treated with VEGF were divided into the < 300 m group and the > 300 m group. Patients’ clinical baseline information was collected(age,gender,duration) and single factor analysis and multifactor regression analysis were made to analyze the prognosis(retinal thickness in central macula) and influencing factors of patients with macular edema with retinal vein occlusion. Results In the study group and the control group, BCVA was significantly increased, CMT was significantly reduced, and intraocular pressure was reduced(P < 0.05). After 12 weeks of treatment, BCVA in the study group was higher than that in the control group, CMT was smaller than that in the control group, and intraocular pressure was lower than that in the control group(P < 0.05). After 24 weeks of treatment, the total effective rate of the study group was higher than that of the control group(P < 0.05). No adverse reactions occurred during the treatment. Conclusion The duration of the disease and baseline CMT were independent factors affecting the thickness of the retina at the center of the macula after 3 months of treatment. Anti-vegf drugs have significant efficacy and high safety in the treatment of retinal vein occlusion and macular edema. Among all factors, baseline CMT and course of disease can be used as good predictors for clinicians to predict the prognosis of patients with RVO and ME.