视网膜分支静脉阻塞继发黄斑水肿抗VEGF治疗后复发的相关因素分析

Analysis of related factors for macular edema recurrence secondary to branch retinal vein occlusion after anti-VEGF therapy

目的探索视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)在抗血管内皮生长因子(VEGF)治疗后ME复发的相关因素。方法回顾性病例研究。从北京医院2015至2021年门诊确诊为BRVO-ME的患者中挑选出45例(45只眼)患者(男性28例,女性17例)被纳入研究,年龄(58.89±10.86)岁(35~83岁)。所有患者均采用3+PRN治疗方案行玻璃体腔雷珠单抗注射(IVR)治疗,且在前3次治疗后相干光层析成像术(OCT)上黄斑中心1 mm区域内未见明显视网膜囊样水肿和隆起(ME消退状态)。12个月内只需注射3次的患者被纳入水肿消退组,注射次数>3的患者被纳入水肿复发组。比较两组之间的病程、黄斑无血管区(FAZ)结构参数、黄斑区血流密度、视网膜厚度的差异,并分析这些临床指标与12个月内IVR次数之间的相关性。结果水肿复发组25只眼,水肿消退组20只眼,两组12个月内IVR次数分别为5.80±1.12和3.00。水肿复发组和水肿消退组治疗前病程时间的差异有统计学意义(U=158.500,P=0.029)。水肿复发组和水肿消退组的FD-300平均血流密度差异有统计学意义(t=2.470,P=0.018)。两组间黄斑区、缺血象限视网膜厚度的差异均无统计学意义(P>0.05)。12个月内IVR次数与FAZ面积、FAZ周长、FAZ非圆指数呈负相关,有统计学意义(P<0.05)。结论FAZ旁血流密度保存良好、黄斑微血管结构损害严重,提示ME不易复发,所需抗VEGF注射次数越少。

Objective To analyze the predictive factors for macular edema(ME)secondary to branch retinal vein occlusion(BRVO)after intravitreal anti-vascular endothelial growth factor(VEGF)treatments.Methods A retrospective study.45 eyes of 45 patients(28 males and 17 females)diagnosed as BRVO-ME in the Beijing Hospital outpatient department from 2015 to 2021 were included in the study,with an average age of(58.89±10.86)years.All patients were treated with intravitreal Ranibizumab injections(IVR)once a month in the first three months and then treated if ME recurred.In 12~month follow-ups,patients treated with only 3 injections were included in the edema regression group while those with more than 3 injections were included in the edema recurrence group.The course of disease,structural parameters of foveal avascular zone(FAZ),macular vessel density,retinal thickness and best corrected visual acuity(BCVA)between the two groups were compared.The correlations between the number of IVR and the structural parameters of FAZ,macular vessel density and retinal thickness were analyzed.Results There were 25 eyes in the edema recurrence group and 20 eyes in the edema regression group.The number of IVR injections in the two groups within 12 months were 5.80±1.12 and 3.00 respectively.The median(quartile)duration of edema recurrence group and edema regression group before treatment were 1.00(0.00,1.50)month and 2.00(1.00,2.75)months respectively,and the difference was significant(U=158.500,P=0.029).The mean vessel density of FD-300 in edema recurrence group and edema regression group were(40.88±8.54)%and(46.12±4.55)%respectively,and the difference was significant(t=2.470,P=0.018).There was no significant difference in retinal thickness between the two groups(P>0.05).The number of IVR within 12 months was negatively correlated with FAZ area(r=-0.308,P=0.033),FAZ perimeter(r=-0.345,P=0.020)and FAZ acircularity index(r=-0.353,P=0.017).Conclusions The good preservation of vessel density around FAZ and serious damage of FAZ structure may contribute to macular edema regression and fewer intravitreal anti-VEGF injections.