摘要目的 观察玻璃体腔注射康柏西普治疗视网膜静脉阻塞(RVO)黄斑水肿短期疗效.方法 回顾性病例研究.通过眼底彩色照相、荧光素眼底血管造影及光相干断层扫描(OCT)检查确诊为RVO黄斑水肿的34例患者34只眼纳入研究.所有患眼均采用国际标准视力表检测最佳矫正视力(BCVA),并将结果转换为最小分辨角对数(logMAR)视力记录.患眼平均logMAR BCVA为0.90±0.68.OCT检查发现,患眼平均黄斑中心凹视网膜厚度(CMT)为(672.27±227.51) μm.所有患眼均行玻璃体腔注射10 mg/ml的康柏西普0.05 ml(含康柏西普0.5 mg)治疗.第1次为初始治疗,然后每一个月复查,根据BCVA及OCT检查结果按需进行同样剂量重复治疗.34只眼共注射69次,平均注射次数(2.03±1.03)次.治疗后1周及1、2、3、6个月重复行BCVA、OCT检查,对比观察患眼治疗前后BCVA、CMT变化以及治疗后药物和治疗方式相关的心脑血管意外及持续性眼压升高、医源性白内障、视网膜脱离、视网膜撕裂、眼内炎等全身不良反应和眼部并发症发生情况.采用直线相关分析法分析治疗后6个月BCVA与治疗前BCVA、CMT的相关性以及治疗前后各时间点BCVA、CMT的相关性.结果 治疗后1周及1、2、3、6个月,患眼平均logMAR BCVA分别为0.65±0.61、0.56±0.61、0.46±0.55、0.56±0.71、0.44±0.48.与治疗前平均logMAR BCVA比较,治疗后1周患眼平均logMAR BCVA无明显变化,差异无统计学意义(Z=21.941,P＞0.05);治疗后1、2、3、6个月患眼平均logMAR BCVA明显提高,差异均有统计学意义(Z=34.029、47.294、41.338、43.603,P＜0.05).治疗后1周及1、2、3、6个月,患眼平均CMT分别为(285.89±96.69)、(256.65±143.39)、(278.68±156.92)、(290.11±188.17)、(217.15±48.04) μm.与治疗前平均CMT比较,治疗后各时间点患眼平均CMT均明显降低,差异有统计学意义(Z=68.500、98.735、93.235、91.132、109.162,P＜0.05).相关性分析结果显示,患眼治疗后6个月BCVA与治疗前BCVA呈正相关(r=0.682,P＜0.05);与治疗前CMT无相关性(r=0.078,P＞0.05).患眼治疗前及治疗后3、6个月BCVA与CMT呈负相关(r=0.491、0.416、0.386,P＜0.05),其余各时间点BCVA与CMT无相关性(r=0.145、0.217、0.177,P＞0.05).随访期间未发现心脑血管意外等全身不良反应及持续性眼压升高、医源性白内障、视网膜脱离、视网膜撕裂、眼内炎等眼部并发症.结论 玻璃体腔注射康柏西普治疗RVO黄斑水肿安全、有效,能提高患眼视力,降低CMT.

abstractsObjective To investigate the effects of intravitreous injection of conbercept for macular edema secondary to retinalvein occlusion(RVO) during 6 months period.Methods A retrospective clinical study.34 patients (34 eyes) were included in this study,who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography and other methods.The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart,and the results were converted to the logMAR visual acuity.The average logMAR BCVA was 0.90 ± 0.68,and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment.All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit.Injections were repeated based on the visual acuity changes and the OCT findings.34 eyes received 69 times of injection,the average number of injections was 2.03 ± 1.03.BCVA,OCT were examined before and after treatment using the same method.BCVA and CMT changes,drugs and treatments associated cardiac and cerebral vascular accident,intraocular pressure elevation,retinal tears,retinal detachment,endophthalmitis and other complications after treatment were observed.Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA,correlation between prognosis BCVA and baseline CMT,and also correlation between BCVA and CMT at different time points before and after treatment.Results At 1 week and 1,2,3,6 months after treatment,the average logMAR BCVA was 0.65±0.61,0.56±0.61,0.46±0.55,0.56±0.71,0.44±0.48 respectively.During 1,2,3,6 months after treatment,the mean logMAR BCVA were improved with statistically significant difference (Z=34.029,47.294,41.338,43.603;P＜0.05),while 1 week after treatment showed no obvious improvement (Z=21.941,P＞0.05).At 1 week and 1,2,3,6 months after treatment,the average CMT was (285.89 ± 96.69),(256.65 ± 143.39),(278.68 ± 156.92),(290.11 ± 188.17),(217.15 ± 48.04) μm respectively.At 1 week and 1,2,3,6 months after treatment,the mean CMT were all decreased with statistically significant difference (Z=68.500,98.735,93.235,91.132,109.162;P＜0.05).There was a positive correlation between the prognosis visual acuity and preoperative visual acuity (r=0.682,P＜0.05).However,there was no correlation between the prognosis vision and the degree of macular edema before treatment (r=0.078,P＞0.05).Before and 3,6 months after treatment,BCVA was negatively correlated with CMT (r=0.491,0.416,0.386;P＜0.05),while there was no correlation in other time points (r =0.145,0.217,0.177;P＞ 0.05).Systemic adverse reactions and persistent intraocular pressure elevation,iatrogenic cataract,retinal detachment,retinal tear,endophthalmitis and ocular complications were never found in the follow-up period.Conclusion Intravitreal conbercept is a safe and effective approach for RVO,which can significantly improve visual acuity and reduce CMT.