摘要目的 研究玻璃体腔注射康柏西普(conbercept)治疗视网膜分支静脉阻塞(BRVO)继发的不同类型黄斑水肿(ME)患者的临床疗效.方法 前瞻性病例对照研究设计.选取2016年5月至2017年5月在潍坊眼科医院确诊的BRVO继发ME患者共56例56眼,根据初诊时光相干断层扫描(OCT)的ME形态分为浆液性神经上皮层脱离型水肿(SRD)型ME患者15例15眼、黄斑囊样水肿(CME)型ME患者19例19眼和混合型ME 22例22眼,所有患者采用1+PRN的方案进行玻璃体腔注射conbercept 0.5 mg/0.05 ml,随访6个月,黄斑中心凹视网膜厚度(CMT)增加超过100 μm时重复注射,比较3个组组内及组间治疗前,治疗后1周、1个月、6个月最佳矫正视力(BCVA,LogMAR视力)、CMT及每种水肿类型6个月内平均注射次数. 结果 3个组患者治疗前后不同时间点BCVA(LogMAR视力)比较,差异均有统计学意义(F分组=105.834,P=0.000;F帅=68.070,P=0.000).治疗后1个月,SRD型ME组BCVA最好,CME型ME组次之,混合型ME组BCVA最差,其中SRD型ME组与混合型ME组差异有统计学意义(P＜0.05).治疗后6个月,SRD型ME组BCVA最好,CME型ME组次之,混合型ME组BCVA最差,两两比较差异均有统计学意义(均P＜0.05).治疗后各组BCVA均较治疗前明显提高,治疗后6个月各组BCVA均较治疗后1周和治疗后1个月明显提高,差异均有统计学意义(均P＜0.05).3个组患者治疗前后不同时间点CMT比较,差异均有统计学意义(F分组=68.640,P=0.000;F时间=29.783,P=0.000).治疗前混昆合型ME组CMT较SRD型ME组和CME型ME组明显增厚,差异均有统计学意义(均P＜0.05).治疗后各组CMT均较治疗前明显变薄,差异均有统计学意义(均P＜0.05);随着治疗时间的延长,各组CMT均逐渐变薄,治疗后1周、1个月、6个月各组CMT两两比较,差异均有统计学意义(均P＜0.05).3个组患者治疗6个月需注射次数比较,差异有统计学意义(F=12.479,P=0.000),其中SRD型ME组注射次数均较CME型ME组和混合型ME组明显减少,差异均有统计学意义(P=0.001、0.000).治疗后6个月仍需继续治疗或需接受激光治疗的患者中,SRD型ME患者1例,占6.7％,CME型ME患者3例,占15.8％,混合型ME患者5例,占22.7％. 结论 玻璃体腔注射cobercept对于治疗BRVO引起的不同类型ME患者疗效确切,能够有效提高患者的BCVA,减轻ME,其中,SRD型ME患者平均需注射次数最少,疗效最佳;其次为CME型ME患者;混合型ME患者平均需注射次数最多,疗效最差.

abstractsObjective To investigate the clinical efficacy of intravitreal injection of conbercept on different types of macular edema (ME) induced by branch retinal vein occlusion (BRVO).Methods A prospective casecontrol study was designed.Fifty-six eyes of 56 patients diagnosed with ME secondary to BRVO in Weifang Eye Hospital between May 2016 and May 2017 were chosen for this study.According to the morphologies of ME through optical coherence tomography (OCT),patients were divided into 3 groups:15 cases 15 eyes with serous retinal detachment (SRD),19 cases 19 eyes with cystoid macular edema (CME),and 22 cases 22 eyes with mixed edema.All of the patients received intravitreal injection of conbercept using "1 +PRN" method and followed up for 6 months.When the change of central macular thickness (CMT) exceed 100 μm,repeat the injection.The best corrected visual acuity (BCVA) and CMT before and after treatment for 1 week,1 month and 6 months and the average injection times were compared among different groups and time points.This study was approved by the Ethic Committee of Weifang Ophthalmic Hospital.Informed consent was signed from each patient before any treatments were proceeded.Results The differences of BCVA (LogMAR vision) at different time points before and after treatment among the 3 groups were statistically significant (Fgroup =105.834,P =0.000;Ftime =68.070,P =0.000).One month after treatment,BCVA in SRD group was the best,the next was CME group,and BCVA in mixed edema group was the poorest,and the difference between SRD group and mixed edema group was statistically significant (P＜ 0.05).Six months after treatment,BCVA in SRD group was the best,the next was CME group,and BCVA in mixed edema group was the poorest,the differences compared with each other were statistically significant (all at P＜0.05).The BCVA after treatment were improved than those before treatment in all the three groups,BCVA in 6 months after treatment was improved than that in 1 week and 1 month after treatment in each group,the differences were statistically significant (all at P＜0.05).The differences of CMT at different time points among the 3 groups were statistically significant (Fgroup =68.640,P =0.000;Ftime =29.783,P =0.000).CMT in mixed edema group before treatment was thicker than that in the SRD group and CME group,with significant differences between them (all at P＜0.05).The CMT after treatment were thinner than those before treatment in 3 groups,with significant differences between them (all at P＜0.05).With the extension of time,CMT was thinner gradually in each group,the differences of CMT in 1 week,1 month,6 months after treatment were statistically significant (all at P＜0.05).The number of injections in 6 months was statistically different among the three groups (F =12.479,P =0.000).The number of injections in SRD group was less than that in the CME group and mixed edema group,and the differences were statistically significant (P =0.001,0.000).Among the patients who still need to be injected or laser treatment after 6 months of treatment,1 patient was SRD type ME (6.7％),3 patients were CME type ME (15.8％),and 5 patients were mixed type ME (22.7％).Conclusions The efficacy of intravitreal injection with conbercept on different types of ME induced by BRVO was definitive,which can effectively improve BCVA and reduce ME;of which,the number of average injection times in SRD group is the least and its prognosis is best,just followed by CME group,while the number of injection times in mixed edema group is the largest and its prognosis is the poorest.