康柏西普联合激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿患者远期视力恢复的影响因素研究

Prognostic factors for visual outcome after injection of Conbercept combined with laser photocoagulation for macular edema due to branch retinal vein occlusion

目的分析并评估影响康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)远期视力恢复的因素。方法回顾性病例分析。将2019年1月至2020年1月在我院眼科查确诊的缺血型BRVO继发ME(BRVO-ME)患者30例30眼纳入研究。所有纳入研究患者均进行裂隙灯检查、最佳矫正视力(BCVA)、光学相干断层扫描(OCT)和光学相干断层扫描血管成像(OCTA)检查,同时测量治疗前后视网膜浅层毛细血管网(SCP)血流密度、黄斑中心凹无血管区域(FAZ)面积和周长,并测量黄斑中心凹厚度(CMT)。定义随访6个月之后的BCVA为远期视力,分析远期视力与基线视力、CMT和OCTA检查参数的相关性。结果与治疗前相比,治疗6个月后患眼BCVA明显提高,CMT下降显著,差异均有统计学意义(t=11.917、11.334,均为P=0.000);SCP血流密度有所降低,但差异无统计学意义(t=1.726,P>0.05);FAZ面积和周长较治疗前均明显增加,差异均有统计学意义(t=-2.554、-6.394,均为P<0.05)。BRVO-ME眼患者注药次数为(2.40±0.89)次。Pearson相关性分析结果显示,远期BCVA与治疗前BCVA、治疗后1个月BCVA降低值以及治疗后1个月CMT下降值均呈正相关(均为P<0.05),而与治疗后1个月SCP血流密度下降值呈负相关(P<0.05),与年龄、治疗前SCP血流密度、治疗前CMT均无相关性(均为P>0.05)。结论治疗前BCVA、黄斑血流灌注情况、首次治疗后CMT下降程度可作为评估BRVO-ME患者远期视力恢复的影响因素。

Objective To analyze and evaluate the predictive factors that influence the long-term vision recovery after the treatment of branch retinal vein occlusion(BRVO)secondary to macular edema(ME)with anti-VEGF combined with retinal laser photocoagulation.Methods Retrospective case analysis.Patients with ischemic BRVO secondary ME(BRVO-ME)diagnosed in the ophthalmology department of our hospital from January 2019 to January 2020 were included in the study,with 30 patients and 30 eyes.All patients included in the study underwent slit lamp examination,best corrected visual acuity(BCVA),optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)examinations,while superficial apillary plexus(SCP)blood flow density,foveal avascular area(FAZ)area and perimeter(PERIM)and manual measurement of central macular thickness(CMT)were measured before and after treatment.The logMAR BCVA after 6 months of follow-up was defined as long-term visual acuity.The correlation between long-term vision and baseline vision,CMT and OCTA parameters were analyzed.Results Compared with preoperative data,after 6 months of treatment,the BCVA of the affected eye was significantly increased,and the CMT declined obviously,and the differences were statistically significant(t=11.917,11.334,both P=0.000);SCP blood flow density decreased,but there was no statistical difference(t=1.726,P>0.05);the area of FAZ and PERIM increased significantly compared with before treatment,and the difference was statistically significant(t=-2.554,-6.394,both P<0.05).The average number of injections for BRVO-ME eyes was(2.40±0.89)times.Pearson correlation analysis results showed that long-term logMAR BCVA was positively correlated with logMAR BCVA before treatment,the decrease in logMAR BCVA one month after treatment,and the decrease in CMT one month after treatment(all P<0.05)and was negatively correlated with blood flow density decrease(P<0.05),and there was no correlation with age,SCP blood flow density before treatment,and CMT before treatment(all P>0.05).Conclusion The best corrected visual acuity before treatment,macular blood perfusion,and the degree of CMT decline after the first treatment can be used as predictors of long-term vision recovery of patients with BRVO-ME.