玻璃体腔注射贝伐单抗治疗视网膜分支静脉阻塞合并黄斑水肿疗效分析

摘要

Objective To compare the efficacy of intravitreal bevacizumab (IVB) in the treatment of macular edema,with or without foveal hemorrhage within the foveal cystoid apaces,subretinal hemorrhage (SRH) and serous retinal detachment (SRD) resulting from branch retinal vein occlusion (BRVO).Methods A retrospective review of 33 consecutive patients (33 eyes) was conducted with ME caused by acute BRVO.All patients received a comprehensive ophthalmologic examination,including measurement of best-corrected visual acuity (BCVA),measurement of intraocular pressure,slit-lamp biomicroscopy,color fundus photograghy,fluorescein angiography,and spectral domain optical coherence tomography (SD-OCT).Using hemorrhage within the foveal cystoid apaces,subretinal hemorrhage (SRH) and serous retinal detachment (SRD) three factors,the multiple logistic model were developed.Results Foveal SRH was closely correlated with BCVA.Patients were classified into one of two groups depending on whether or not foveal SRH was detected at the initial visit,BCVA and central macular thickness (CMT) were observed.After 6 months,SD-OCT revealed serous retinal detachments in the fovea of 15 eyes,10 of which had accompanying foveal SRH.Based on initial detection of foveal SRH,patients were divided into SRH-negative (23 eyes) or SRH-positive (10 eyes) groups.Initial BCVA did not differ between the two groups.In the SRH-negative group,both BCVA and CMT improved significantly after IVB injections (mean,2.3 injections) at the 6-months follow-up examination.In the SRH-positive group,there was no significant improvement in BCVA after IVB injections (mean,2.0 injections),although there was a significant decrease in CMT.The final BCVA of the SRH-positive group was significantly poorer than that of the SRH-negative group (P =0.001).Conclusions The presence of foveal SRH may be a negative predictor of IVB treatment outcomes for BRVO patients with ME.%目的 观察玻璃体腔注射贝伐单抗(IVB)治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿时,黄斑中心凹视网膜内出血、浆液性视网膜脱离(SRD)、视网膜下出血(SRH)对治疗效果的影响.方法 回顾性研究2012年2月至2013年8月在北京大学第三医院眼科临床确诊为BRVO继发黄斑水肿的33例(33只眼)患者的临床资料.所有患者治疗前后均行最佳矫正视力(best-corrected visual acuity BCVA)、眼压、裂隙灯、间接眼底镜、彩色眼底照相、荧光素眼底血管造影、频域光学相干断层扫描(SD-OCT)检查.以中心凹视网膜内出血、中心凹SRD、中心凹SRH、三个变量为基础构建多因素logistic回归模型,观察其与BCVA的关系.根据治疗前SD-OCT检查有无中心凹处SRH将患者分为SRH(-)组及SRH(+)组,随访6个月,观察两组BCVA及黄斑中心凹厚度(central macu-lar thickness CMT)的变化.结果 SRH(-)组,经平均2.3次IBV注射治疗后,BCVA及CMT均明显好转;SRH(+)组,经平均2.0次IBV注射治疗后,虽然CMT较前明显下降,但BCVA无明显提高;两组BCVA差异有统计学(P=0.001).结论 黄斑中心凹SRH是IVB治疗BRVO继发黄斑水肿预后不良的影响因素.