摘要目的:观察玻璃体腔注射康柏西普（IVC）治疗新生血管性老年性黄斑变性（nAMD）中1型黄斑新生血管（MNV）伴不同类型视网膜色素上皮脱离（PED）的疗效。方法:回顾性临床研究。2018年6月至2021年6月于解放军中部战区总医院眼科检查确诊的nAMD中1型MNV伴不同类型PED患者42例42只眼纳入研究。所有患眼均行最佳矫正视力（BCVA）及光相干断层扫描（OCT）检查。OCT检查采用日本Topcon公司3D-OCT 2000仪进行，对黄斑中心凹进行扫描，测量其PED高度（PEDH）、PED面积（PEDA）、PED体积（PEDV）、黄斑中心凹厚度（CFT）。根据PED的OCT图像特征，将患眼分为浆液性PED （sPED）、纤维血管性PED （fPED）、出血性PED （hPED），并据此分组。42只眼中，sPED组、fPED组、hPED组分别为16 （38.1%，16/42）、14 （33.3%，14/42）、12 （28.6%，12/42）只眼。所有患者均接受IVC治疗，每一个月1次，连续3个月，其后经评估按需治疗。治疗后3、6、12个月复查BCVA及OCT，对比观察治疗前后患眼BCVA、PEDH、PEDA、PEDV、CFT变化，并采用重复测量方差分析进行统计分析。结果:治疗后12个月，sPED组、fPED组、hPED组患眼PEDH、PEDA、PEDV均较治疗前显著降低，差异有统计学意义（ P<0.05 ）。其改善程度的差值，hPED组分别为（-318.67±258.09） μm、（-6.50±6.33 ）μm 2、（-1.95±1.78） μm 3；sPED组分别为（-119.31±224.13） μm、（-0.86±5.00） μm 2、（-0.56±1.64） μm 3；fPED组分别为（-53.93±92.51 ） μm、（-0.76±2.54） μm 2、（-0.19±0.46）μm 3。hPED组患眼改善程度显著大于sPED组、fPED组，差异有统计学意义（ F=5.918、6.029、5.494， P<0.05 ）。与治疗前BCVA、CFT比较，治疗后12个月，fPED组、hPED组差异均有统计学意义（ P<0.05 ）；sPED组无显著改善（ P>0.05）。3组患眼BCVA与治疗前变化幅度的差值比较，差异无统计学意义（ F=0.817、0.741、0.848， P>0.05 ）。 结论:康柏西普能有效改善或稳定nAMD中1型MNV伴sPED、fPED、hPED患眼的视功能及解剖学形态，其中对hPED的解剖学疗效更好。

abstractsObjective:To observe the efficacy of intravitreal injection of conbercept (IVC) in the treatment of type 1 macular neovascularization (MNV) with different types of pigment epithelial detachment (PED) in neovascular age-related macular degeneration (nAMD).Methods:A retrospective clinical study. From June 2018 to June 2021, 42 patients with 42 eyes of nAMD type 1 MNV patients with different types of PED diagnosed in the ophthalmological examination of the Department of Ophthalmology, General Hospital of Central Theater Command were included in the study. All eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT). The OCT examination was performed with a 3D-OCT 2000 instrument from Topcon Company in Japan. The fovea was scanned, and the PED height (PEDH), PED area (PEDA), PED volume (PEDV), and central foveal thickness (CFT) were measured. According to the OCT image features of PED, the affected eyes were divided into serous PED (sPED), fibrovascular PED (fPED), and hemorrhagic PED (hPED), and were grouped accordingly. Among the 42 eyes, 16 (38.1%, 16/42), 14 (33.3%, 14/42), and 12 (28.6%, 12/42) eyes were in the sPED group, fPED group, and hPED group, respectively. All patients received IVC treatment once a month for 3 consecutive months, and then on-demand treatment after assessment. BCVA and OCT were re-examined 3, 6, and 12 months after treatment, and the changes of BCVA, PEDH, PEDA, PEDV, and CFT in the affected eyes before and after treatment were compared, and repeated measures analysis of variance was used for statistical analysis.Results:At 12 months after treatment, the PEDH, PEDA and PEDV of the affected eyes in the sPED group, fPED group and hPED group were significantly lower than those before treatment, and the difference was statistically significant ( P<0.05). The difference in the degree of improvement was -318.67±258.09 μm, -6.50±6.33 μm 2, -1.95±1.78 μm 3 in the hPED group; -119.31±224.13 μm, -0.86 ±5.00 μm 2, -0.56±1.64 μm 3 in the sPED group; fPED group were -53.93±92.51 μm, -0.76±2.54 μm 2, -0.19±0.46 μm 3. The improvement degree of the affected eyes in hPED group was significantly greater than that in sPED group and fPED group, and the difference was statistically significant ( F=5.918, 6.029, 5.494; P<0.05). Compared with the BCVA and CFT before treatment, 12 months after treatment, the difference was statistically significant in the fPED group and the hPED group ( P<0.05); there was no significant improvement in the sPED group ( P>0.05). There was no significant difference in the BCVA of the affected eyes in the three groups compared with those before treatment ( F=0.817, 0.741, 0.848; P>0.05). Conclusion:Conbercept can effectively improve or stabilize the visual function and anatomical morphology of eyes with type 1 MNV in nAMD with sPED, fPED and hPED, among which the anatomical effect is better for hPED.