目的：探究病理性近视脉络膜新生血管(PM-CNV)患者玻璃体内注射抗血管内皮生长因子(VEGF)药物的远期疗效及其影响因素。

方法：回顾性病例对照研究。分析2020年1月至2023年2月在南阳南石医院接受玻璃体内注射抗VEGF药物治疗的145例PM-CNV患者的临床资料，观察患者治疗前后不同时间点的最佳矫正视力(BCVA)及黄斑中心视网膜厚度(CMT)情况； 根据随访2 a预后情况将患者分为疗效良好组和疗效不良组，比较两组患者一般资料，多因素Logistic回归分析患者疗效不良的影响因素； 基于影响因素构建PM-CNV患者疗效不良的风险预测模型，采用受试者工作特征(ROC)曲线评估该模型的预测价值。

结果：与治疗前相比，治疗后1、3、6、12、24 mo CMT显著降低、BCVA显著改善(均P<0.05)。与治疗后1 mo相比，治疗后3、6、12、24 mo CMT显著降低、BCVA显著改善(均P<0.05)。与治疗后3 mo相比，治疗后6、12、24 mo CMT显著降低、BCVA显著改善(均P<0.05)。与治疗后6 mo相比，治疗后24 mo BCVA显著改善(P<0.05)。相较于疗效良好组，疗效不良组患者年龄≥50岁占比更高，病程更长、注射次数更多、治疗前BCVA较差、治疗前CMT更厚(均P<0.05)。病程长、注射次数较多、治疗前BCVA较差、治疗前CMT厚是PM-CNV患者玻璃体内注射抗VEGF药物疗效不良的影响因素(均P<0.05)。基于影响因素构建联合预测模型，ROC结果显示，该联合模型预测PM-CNV患者疗效不良的曲线下面积(AUC)为0.756(95%CI：0.678-0.824)，灵敏度86.27%、特异度62.77%、约登指数0.490，该联合模型预测效能良好。

结论：抗VEGF药物能改善PM-CNV患者视力，降低CMT，其中病程长、注射次数较多、治疗前BCVA较差、治疗前CMT较厚是PM-CNV患者疗效不良的影响因素。

METHODS: Retrospective case control study. The clinical data of 145 patients with PM-CNV who received intravitreal injection of anti-VEGF drugs at Nanshi Hospital of Nanyang from January 2020 to February 2023 were analyzed. The best corrected visual acuity(BCVA)and central macular retinal thickness(CMT)of the patients at different time points before and after treatment were observed. According to the prognosis after 2-year follow-up, the patients were divided into good therapeutic effect group and poor therapeutic effect group. The general data of the two groups of patients were compared, and multivariate Logistic regression analysis was conducted to analyze the related factors affecting the poor therapeutic effect of the patients. A risk prediction model for poor therapeutic effect on PM-CNV patients was constructed based on relevant factors, and the predictive value of this model was evaluated by using the receiver operating characteristic(ROC)curve.

RESULTS: Compared with before treatment, CMT significantly decreased and BCVA significantly increased at 1, 3, 6, 12 and 24 mo after treatment(all P<0.05). Compared with 1 mo after treatment, CMT was significantly decreased and BCVA was significantly increased at 3, 6, 12, and 24 mo after treatment(all P<0.05). Compared with 3 mo after treatment, CMT was significantly decreased and BCVA was significantly increased at 6, 12, and 24 mo after treatment(all P<0.05). Compared with 6 mo after treatment, BCVA significantly improved at 24 mo after treatment(P<0.05). Compared with the good therapeutic effect group, the proportion of patients aged ≥50 years in the poor therapeutic effect group was larger, the disease course was longer, the number of injections was more, the BCVA before treatment was poorer and the CMT was thicker(all P<0.05). Long disease course, large number of injections, low BCVA before treatment, and thick CMT are the related factors for poor efficacy of intravitreal injection of anti-VEGF drugs in patients with PM-CNV(all P<0.05). A combined prediction model was constructed based on influencing factors. The ROC results showed that the area under the curve(AUC)of this combined model for predicting poor therapeutic effect in PM-CNV patients was 0.756(95% CI: 0.678-0.824), with a sensitivity of 86.27%, a specificity of 62.77%, and a Youden index of 0.490. The combined model has good predictive performance.

CONCLUSION: Anti-VEGF drugs can improve visual acuity and reduce CMT in patients with PM-CNV. Among them, long disease course, more injection times, lower BCVA before treatment, and thick CMT are related factors for poor therapeutic effect on patients with PM-CNV.