玻璃体黄斑粘连对视网膜分支静脉阻塞继发黄斑水肿行康柏西普治疗效果的影响

摘要

目的:观察玻璃体黄斑粘连对视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)行康柏西普治疗效果的影响.方法:回顾性病例研究.将2014-04/2016-05就诊于我院眼科门诊符合入选标准的BRVO继发ME患者58例60眼纳入本研究.通过光学相干断层扫描图像(SD-OCT)检查将是否合并有玻璃体黄斑粘连分为两组,合并玻璃体黄斑粘连组(A组)和不合并玻璃体黄斑粘连组(B组).A组23例24眼,平均年龄55.91±7.34岁,平均发病时间3.4±1.01mo.黄斑中心凹视网膜厚度(CMT)为463.26±53.73 μm,平均最佳矫正视力(LogMAR)为0.63±0.11.B组35例36眼,平均年龄56.33 ±5.34岁,平均发病时间2.82±1.33mo. CMT为482.90±37.43μm,BCVA为0.59±0.12.两组患者均给予玻璃体腔内注射康柏西普0.5mg.根据BCVA及OCT检查结果按需进行同样剂量重复治疗,随诊6mo.记录两组患者治疗前及治疗后1、6moBCVA、CMT、重复注射次数等.结果:合并玻璃体黄斑粘连组平均注射次数4.38 ±0.97次,未合并玻璃体黄斑粘连组平均注射次数3.56±0.71次,两组患者平均注射次数比较,差异有统计学意义(t=4.56,P＜0.05).治疗后1、6mo,两组患者的BCVA、CMT与治疗前相比,差异均有统计学意义(P＜0.05).两组组间比较,治疗后1、6mo时BCVA差异无统计学意义(t=2.13、5.32,P＞0.05),但CMT比较差异有统计学意义(t=9.13、10.01,P＜0.05).所有患者随访期间均未出现高眼压、眼内炎、玻璃体积血、视网膜脱离及心血管疾病等眼部并发症和全身不良反应.结论:玻璃体腔内注射康柏西普治疗BRVO继发的ME具有良好的临床效果,但是如果同时合并有玻璃体黄斑粘连,则在一定程度上会减弱抗VEGF的治疗效果.%AIM:To observe the the effect of vitreomacular adhesion on the anti-vascular endothelial growth factor (VEGF) treatment in patients with macular edema (ME) induced by branch retinal vein occlusion (BRVO).METHODS:A retrospective clinical study.Totally 58 patients(60 eyes) were induced in this study during April 2014 to May 2016,who were diagnosed with macular edema due to branch retinal vein occlusion.All subjects were assigned to 2 groups according to the examination of optical coherence tomography (OCT):combined with vitreomacular adhesion groups (Group A) and uncombined with vitreomacular adhesion groups (Group B).The basic situation of the two groups was as follows:Group A:23 cases (24 eyes),the average age was 55.91± 7.34,the mean disease course was 3.4±1.01mo,the mean macular central retinal thickness (CMT) was 463.26±53.73μm and the average BCVA was 0.63±0.11;Group B:35 cases (36 eyes),the average age was 56.33± 5.34,the mean disease course was 2.82± 1.33mo,the mean CMT was 482.90± 37.43μ m and the average BCVA was0.59±0.12.All cases received vitreous injection of 0.5mg Conbercept.Injections were repeated based on the visual changes and the OCT findings.The follow-up time was more than 6mo.BCVA,CMT,and the numbers of injections of two groups were recorded at pre-operation and postoperative 1,6mo and the statistical analysis was conducted.RESULTS:BCVA and CMT of the most patients were improved compared to prior treatment and the difference had statistical significance (P ＜ 0.05).There were significant differences on CMT between two groups at 1 and 6mo after treatment (t=9.13,10.01;P＜0.05).While BCVA between two groups at 1 and 6mo after treatment was not statistically different (t=2.13,5.32;P＞0.05).At 6mo after treatment,the average numbers of injections in combined vitreomacular adhesion groups were 4.38±0.97 times and the average numbers of injections in uncombined vitreomacular adhesion groups were 3.56 ± 0.71 times.The difference had statistical significance (t=4.56,P＜ 0.05).Systematic adverse reactions and persistent intraocular pressure elevation,retinal detachment,endophthalmitis,vitreous hemorrhage were never found in the follow-up period.CONCLUSION:Vitreous injection of anti-VEGF treatment for macular edema induced by branch retinal vein occlusion has good clinical results.However,if there is merged with vitreomacular adhesion at the same time,the treatment effect of anti-VEGF will be weakened to some extent.