目的：采用光学相干断层扫描(OCT)图像分析康柏西普对视网膜静脉阻塞继发不同类型黄斑水肿的疗效。

方法：回顾性研究。纳入2017年12月1日至2022年3月31日期间在皖南医学院弋矶山医院首次接受康柏西普注射治疗视网膜静脉阻塞继发黄斑水肿的患者。收集病程、年龄、高血压状况、治疗前及治疗后4-6 wk的OCT影像、黄斑中心凹厚度(CMT)及最佳矫正视力(BCVA)。根据不同黄斑水肿类型将患者分为4组：黄斑囊样水肿(CME)、海绵状弥漫性视网膜增厚(SDRT)、浆液性视网膜脱离(SRD)以及混合型(FULL)。通过比较各组治疗前后CMT与视力的变化，分析康柏西普治疗不同类型黄斑水肿的效果差异，以及基线CMT和视力对治疗后视力的影响。

结果：本研究共纳入139例139眼黄斑水肿患者，平均年龄为58.9±10.9岁，其中男62例(44.6%)，女77例(55.4%)。根据不同类型黄斑水肿分为4组，其中CME组54例54眼，平均年龄59.6±11.1岁； SDRT组23例23眼，平均年龄56.6±10.2岁； SRD组22例22眼，平均年龄57.8±12.0岁； FULL组40例40眼，平均年龄60.0±10.7岁。组间在病程及年龄方面均无显著差异(P>0.05)。然而，组间术前CMT存在显著差异(P=0.01，单因素方差分析)，其中FULL组的CMT显著高于SDRT组(P=0.03)。四组间治疗前BCVA无显著差异(P=0.26)。康柏西普治疗后，四组患者的CMT均降低，视力均得到改善。其中，CME组和FULL组的CMT降低程度显著高于其他两组(P<0.05)，CME组和SRD组的视力改善程度显著高于其他两组(P<0.05)。术后视力与术前CMT呈负相关(P=0.044)，与术前视力呈正相关(P<0.01)。

结论：玻璃体腔内注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿的疗效可能与OCT图像所观察到的水肿类型有关。其中，CME患者疗效最佳，而SDRT患者疗效相对较差。

METHODS: This retrospective study included patients who first received conbercept injections for RVO-ME at Yijishan Hospital of Wannan Medical College from December 1, 2017, to March 31, 2022. Data on disease duration, age, hypertension, OCT images, central macular thickness(CMT), and best-corrected visual acuity(BCVA)were collected before and at 4-6 wk after treatment. Patients were divided into 4 groups according to different types of macular edema: cystoid macular edema(CME), sponge-like diffuse retinal thickening(SDRT), serous retinal detachment(SRD), and mixed type(FULL). Changes in CMT and visual acuity before and after treatment were compared among the groups to analyze differences in the effect of conbercept treatment on different ME types, and the effect of baseline CMT and visual acuity on post-treatment visual acuity.

RESULTS: Totally 139 patients(139 eyes)were classified as having macular edema, including 62 males(44.6%)and 77 females(55.4%), with a mean age of 58.9±10.9 years, and they were divided into 4 groups based on different types of macular edema, including 54 cases(54 eyes)(mean age 59.6±11.1 years)in the CME group, 23 cases(23 eyes; mean age 56.6±10.2 years)in the SDRT group, 22 cases(22 eyes; mean age 57.8±12.0 years)in the SDR group, and 40 cases(40 eyes; mean age 60.0±10.7 years)in the FULL group. There were no significant differences in the duration of disease or age between groups(P>0.05). There was a significant difference in preoperative CMT between groups(P=0.01, one-way ANOVA), with the CMT in the FULL group being significantly greater than that in the SDRT group(P=0.03). There were no significant differences in pre-treatment visual acuity between the four groups(P=0.26). After conbercept treatment, the macular central recess thickness was reduced and visual acuity was improved in all four groups, among which the CMT in the CME and FULL groups was reduced significantly compared with the other two groups(P<0.05), and the visual acuity in the CME and SRD groups was improved significantly compared with the other two groups(P<0.05). Postoperative visual acuity was negatively correlated with preoperative CMT(P=0.044)and positively correlated with preoperative visual acuity(P<0.01).

CONCLUSION:The efficacy of intravitreal conbercept in the treatment of RVO and macular edema may be related to the type of edema observed on OCT images, in which the efficacy is best in patients with CME but poor in patients with SDRT.