摘要目的:对比观察视网膜下注射和玻璃体腔注射康柏西普治疗息肉样脉络膜血管病变（PCV）的临床疗效。方法:前瞻性随机双盲对照研究。2022年6月至2023年1月于南昌大学附属眼科医院检查确诊的PCV患者35例35只眼纳入研究。所有患者均为首次接受治疗者。患眼均行最佳矫正视力（BCVA）、光相干断层扫描（OCT）、吲哚青绿血管造影（ICGA）检查。采用国际标准视力表行BCVA检查，统计时换算为最小分辨角对数（logMAR）视力。采用OCT仪的增强深度成像技术测量患眼中心凹视网膜厚度（MRT）、中心凹下脉络膜厚度（SFCT）、色素上皮脱离（PED）高度。采用随机数字表法将患者分为视网膜下注药组（A组）、玻璃体腔注药组（B组），分别为18例18只眼，17例17只眼。两组患者年龄（ t=0.090）、病程（ t=?0.370）、logMAR BCVA （ t=?0.190）、MRT （ t=0.860）、SFCT （ t=0.247）、PED高度（ t=?0.520）比较，差异均无统计学意义（ P>0.05）。A组患眼均给予1次视网膜下注射10 mg/ml的康柏西普0.05 ml（含康柏西普0.5 mg）治疗，其后按需给药（PRN）；B组患眼玻璃体腔注射10 mg/ml的康柏西普0.05 ml（含康柏西普0.5 mg），治疗方案为3+PRN。根据治疗后OCT、BCVA检测结果将病变分为活动型及静止型。活动型病变给予玻璃体腔注射康柏西普治疗，剂量同前；静止型病变，随访观察。治疗后1、2、3、6、9个月行BCVA、OCT检查；治疗后3、6、9个月同时行ICGA检查。对比观察两组患眼治疗前后BCVA、MRT、SFCT、PED高度的变化情况。两组间比较采用独立样本 t检验。 结果:随治疗后时间延长，A组、B组患眼BCVA逐渐提高，MRT、SFCT、PED高度逐渐降低。与B组比较，治疗后2、3、6、9个月，A组BCVA显著提高，差异有统计学意义（ t=?2.215、?2.820、?2.559、?4.051， P<0.05）；治疗后1、2、3、6、9个月，A组患眼MRT （ t=?2.439、?3.091、?3.099、?3.665、?5.494）、SFCT （ t=?3.370、?3.058、?3.268、?4.220、?4.121）、PED高度（ t=?3.460、?4.678、?4.956、?5.368、?6.396）显著降低，差异均有统计学意义（ P<0.05）。所有患眼治疗中及治疗后均未出现眼内炎、高眼压、玻璃体积血等并发症。 结论:与玻璃体腔注射康柏西普比较，视网膜下注射康柏西普可更为有效地降低PCV患眼MRT、SFCT、PED高度，提高患眼视力。

abstractsObjective:To observe the clinical effect of subretinal injection and intravitreal injection of conbercept in the treatment of polypoid choroidal vasculopathy (PCV).Methods:A prospective, randomized double-blind controlled study. From June 2022 to January 2023, 35 patients of 35 eyes with PCV diagnosed at Affiliated Eye Hospital of Nanchang University were included in the study. All patients were first-time recipients of treatment. Best corrected visual acuity (BCVA), optical coherence tomography (OCT), and indocyanine green angiography (ICGA) were performed in all affected eyes. BCVA was performed using an international standard visual acuity chart and converted to logarithmic minimum resolved angle (logMAR) visual acuity for statistical purposes. Enhanced depth imaging with OCT instrument was used to measure the macular retinal thickness (MRT), subfoveal choroidal thickness (SFCT), and pigment epithelium detachment (PED) height. Randomized numerical table method was used to divide the patients into subretinal injection group (group A) and vitreous cavity injection group (Group B), 18 cases with 18 eyes and 17 cases with 17 eyes, respectively. Comparison of age ( t=0.090), disease duration ( t=-0.370), logMAR BCVA ( t=?0.190), MRT ( t=0.860), SFCT ( t=0.247), and PED height ( t=?0.520) between the two groups showed no statistically significant difference ( P>0.05). The eyes of group A were given one subretinal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg), and subsequently administered on demand (PRN); eyes in group B were given intravitreal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg). The treatment regimen was 3+PRN. Lesions were categorized into active and quiescent according to the results of post-treatment OCT and BCVA. Active lesions were treated with intravitreal injection of conbercept at the same dose as before; stationary lesions were followed up for observation. BCVA and OCT were performed at 1, 2, 3, 6 and 9 months after treatment; ICGA was performed at 3, 6 and 9 months. BCVA, MRT, SFCT, and PED height changes before and after treatment were compared and observed in the affected eyes of the two groups. Independent sample t-test was used to compare between the two groups. Results:With the prolongation of time after treatment, the BCVA of the affected eyes in groups A and B gradually increased, and the MRT, SFCT, and PED height gradually decreased. Compared with group B, at 2, 3, 6, and 9 months after treatment, the BCVA of group A was significantly improved, and the difference was statistically significant ( t=?2.215, ?2.820, ?2.559, ?4.051; P<0.05); at 1, 2, 3, 6, and 9 months after treatment, the MRT of the affected eyes in group A ( t=?2.439, ?3.091, ?3.099, ?3.665, ?5.494), SFCT ( t=?3.370, ?3.058, ?3.268, ?4.220, ?4.121), and PED height ( t=?3.460, ?4.678, ?4.956, ?5.368, ?6.396) were significantly reduced, and the differences were statistically significant ( P<0.05). No complications such as intraocular inflammation, high intraocular pressure, or vitreous hemorrhage occurred in any of the affected eyes during or after treatment. Conclusion:Compared with the intravitreal injection of conbercept, the subretinal injection of conbercept can more effectively reduce the height of MRT, SFCT, PED height, and improve the visual acuity of the affected eyes with PCV.