年龄和OCT特征与抗VEGF治疗视网膜中央静脉阻塞性黄斑水肿效果的相关性

Correlation of age and OCT features with efficacy of anti-VEGF agents for macular edema secondary to central retinal vein occlusion

目的:探讨年龄和OCT特征与抗血管内皮生长因子(VEGF)药物治疗视网膜中央静脉阻塞(CRVO)性黄斑水肿效果的相关性。方法:回顾性病例对照研究。将2017-07/2019-07确诊为CRVO的患者47例47眼纳入研究,根据发病年龄分为老年组(年龄>50岁,27眼)和中青年组(年龄≤50岁,20眼)。所有患者均行玻璃体腔注射抗VEGF治疗(3+PRN),至少随访12mo。观察两组患者治疗前后最佳矫正视力(BCVA)、强反射点(HRD)数量、平均视网膜厚度(ART)、中央视网膜厚度(CRT)变化情况,比较两组患者抗VEGF治疗次数、外界膜(ELM)和椭圆体带(EZ)转归率,并分析影响视力预后的相关指标。结果:抗VEGF治疗后两组患者BCVA均较治疗前改善、HRD数量减少、CRT和ART变薄。治疗后第12mo随访时,老年组患者行玻璃体腔注射抗VEGF药物次数高于中青年组(8.4±2.1次vs 7.3±1.7次,P=0.047),但两组患者ELM、EZ转归率均无差异(P>0.05),老年组患者BCVA与发病年龄、HRD、ELM及EZ具有相关性(均P<0.05),中青年组患者BCVA与发病年龄、ART、HRD、ELM及EZ具有相关性(均P<0.05)。结论:玻璃体腔注射抗VEGF药物可有效治疗CRVO性黄斑水肿,且中青年患者比老年患者预后更好,年龄和OCT指标HRD、ELM及EZ等与视力预后相关。

AIM:To explore the correlation between age,OCT characteristics and the efficacy of anti-vascular endothelial growth factor(VEGF)drugs in the treatment of macular edema secondary to central retinal vein occlusion(CRVO).METHODS:Retrospective case-control study.From July 2017 to July 2019,47 eyes of 47 patients with CRVO were included and divided into group A(elderly group,age>50y,n=27)and group B(young and middle-aged group,age≤50y,n=20).All patients were received anti-VEGF therapy(3+PRN)and followed up for at least 12mo.The best corrected visual acuity(BCVA),the number of hyper-reflective dots(HRD),the average retinal thickness(ART)and central retinal thickness(CRT)were observed before and after treatment.The number of injections,the recovery rate of outer membrane(ELM)and ellipsoidal zone(EZ)were compared between the two groups,and the related indexes affecting visual prognosis were analyzed.RESULTS:After anti-VEGF treatment,BCVA was improved,the number of HRD decreased,CRT and ART thinned in both groups.During the follow up of 12mo after treatment,the frequency of injection of anti-VEGF drugs in the elderly group was higher than that in the young and middle-aged group(8.4±2.1 times vs 7.3±1.7 times,P=0.047),but there was no difference in the recovery rates of ELM and EZ between the two groups.BCVA in the elderly group was correlated with the age,HRD,ELM and EZ(all P<0.05).BCVA was correlated with age,ART,HRD,ELM and EZ in young and middle-aged patients(all P<0.05).CONCLUSION:Intravitreal injection of anti-VEGF drugs can effectively treat macular edema secondary to CRVO and the prognosis of young and middle-aged patients is better than that of elderly patients.Age and OCT indexes such as HRD,ELM and EZ are related to visual prognosis.