摘要：
目的 评价病理性近视脉络膜新生血管(MCNV)玻璃体腔注射康柏西普治疗前后的黄斑视功能.方法前瞻性、无对照、非随机研究.2017年4月至2018年4月在山西省眼科医院确诊为MCNV并经玻璃体腔注射康柏西普治疗的21例21只眼纳入研究.其中,男性9例9只眼(42.86％),女性12例12只眼(57.14％).平均年龄(35.1±13.2)岁,平均屈光度(-11.30±2.35)D,平均眼轴长度(28.93±5.68) mm.采用1 +PRN的治疗方案给予所有患眼玻璃体腔注射康柏西普0.05 ml(含康柏西普0.5 mg)治疗.治疗前及治疗后每月常规复查随访,每次随访均行BCVA及MAIA微视野检查.对比分析患眼治疗前后BCVA及黄斑整体指数(MI)、平均光敏感度(MS)、固视状态改变情况.固视状态分为稳定固视、相对不稳定固视、不稳定固视3种.治疗前后BCVA、MI及MS比较采用配对样本t检验;治疗前后固视状态比较采用x2检验.结果 观察期内患眼平均注射治疗次数3.5次.治疗前及治疗后1、3、6个月患眼logMAR BCVA分别为0.87±0.32、0.68±0.23、0.52±0.17、0.61±0.57;MI分别为89.38±21.34、88.87±17.91、70.59±30.02、86.76±15.09;MS分别为(15.32±7.19)、(21.35±8.89)、(23.98±11.12)、(22.32±9.04) dB.与治疗前比较,治疗后1、3、6个月患眼BCVA(t=15.32、18.65、17.38,P＜0.01)、MS(t=4.08、3.50、4.26,P＜0.01)明显提高,差异有统计学意义.治疗前及治疗后1、3、6个月患眼MI比较,差异无统计学意义(t=0.60、2.42、2.58,P＞0.05).治疗前及治疗后l、3、6个月,稳定固视、相对不稳定固视、不稳定固视患眼比例分别为28.57％、47.62％、23.81％,38.10％、47.62％、14.28％,38.10％、52.38％、9.52％及33.33％、57.14％、9.52％.与治疗前比较,治疗后1、3、6个月稳定固视及相对不稳定固视患眼所占比例较治疗前提高,但差异无统计学意义(x2=1.82、1.24、1.69,P＞0.05).结论 MCNV患眼经玻璃体腔注射康柏西普治疗后BCVA、MS明显提高.%Objective To evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.Methods A prospective,uncontrolled and non-randomized study.From April 2017 to April 2018,21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study.There were 9 males (9 eyes,42.86％) and 12 females (12 eyes,57.14％),with the mean age of 35.1 ± 13.2 years.The mean diopter was-11.30 ± 2.35 D and the mean axial length was 28.93 ± 5.68 mm.All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN).Regular follow-up was performed before and after treatment,and BCVA and MAIA micro-field examination were performed at each follow-up.BCVA,macular integrity index (MI),mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed.The fixation status was divided into three types:stable fixation,relatively unstable fixation,and unstable fixation.The paired-sample t-test was used to compare BCVA,MI and MS before and after treatment.The x2 test was used to compare the fixation status before and after treatment.Results During the observation period,the average number of injections was 3.5.The logMAR BCVA of the eyes before treatment and at 1,3,and 6 months after treatment were 0.87±0.32,0.68±0.23,0.52±0.17,and 0.61 ±0.57,respectively;MI were 89.38 ± 21.34,88.87 ± 17.91,70.59 ± 30.02,and 86.76 ± 15.09,respectively;MS were 15.32 ± 7.19,21.35 ± 8.89,23.98 ± 11.12,22.32 ± 9.04 dB,respectively.Compared with before treatment,BCVA (t=15.32,18.65,17.38;P＜0.01) and MS (t=4.08,3.50,4.26;P＜0.01) were significantly increased in the eyes 1,3,and 6 months after treatment.There was no significant difference in the MI of the eyes before treatment and at 1,3,and 6 months after treatment (t=0.60,2.42,2.58;P＞0.05).Before treatment and at 1,3,and 6 months after treatment,the proportion of stable fixation were 28.57％,38.10％,38.10％,33.33％;the proportion of relatively unstable fixation were 47.62％,47.62％,52.38％,57.14％ and the proportion of unstable fixation were 23.81％,14.28％,9.52％,9.52％,respectively.The proportion of stable fixation and relatively unstable fixation at 1,3 and 6 months after treatment were higher than that before treatment,but the difference was not statistically significant (x2=1.82,1.24,1.69;P＞0.05).Conclusion BCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.
