目的：对比曲安奈德(TA)行巩膜后注射、球周注射、玻璃体腔注射治疗视网膜静脉阻塞性黄斑水肿(RVO-ME)的疗效及安全性。

方法：选取本院2021年6月至2024年9月收治的RVO-ME患者，随机分为A组(巩膜后注射TA)、B组(球周注射TA)、C组(玻璃体腔注射TA)。治疗3 mo后比较三组患者的疗效、最佳矫正视力(BCVA，LogMAR)、黄斑中心凹厚度(CMT)、视网膜中央动脉血流参数及并发症发生情况。

结果：本研究共纳入RVO-ME患者93例93眼，A组、B组、C组各31例31眼。A组年龄50.37±5.71岁，男15例，女16例； B组年龄48.92±5.36岁，男14例，女17例； C组年龄49.66±5.54岁，男18例，女13例。A组的总有效率(94%)大于B、C组(68%、74%)，并发症发生率(6%)低于B、C组(29%、32%)(均P<0.05)。治疗后1、3 mo，A组患者的BCVA为0.46±0.06、0.36±0.04，舒张末期流速(EDV)为11.45±1.79、13.97±2.28 cm/s，收缩期峰值流速(PSV)为2.16±0.31、2.83±0.42 cm/s； B组患者的BCVA为0.55±0.07、0.46±0.05，EDV为9.57±1.38、12.03±2.14 cm/s，PSV为1.93±0.26、2.41±0.39 cm/s； C组患者的BCVA为0.57±0.09、0.48±0.06，EDV为9.39±1.25、11.91±2.06 cm/s，PSV为1.87±0.24、2.35±0.36 cm/s，A组BCVA优于B、C组，A组EDV、PSV大于B、C组(均P<0.05)。治疗后1、3 mo，A组患者的CMT为249.62±29.33、141.13±21.59 μm，阻力指数(RI)为0.71±0.08、0.70±0.08； B组患者的CMT为307.13±34.86、227.99±28.43 μm，RI为0.77±0.09、0.76±0.09； C组患者的CMT为311.42±40.66、232.56±31.44 μm，RI为0.79±0.11、0.78±0.10，A组CMT、RI小于B、C组(均P<0.05)。

结论：三种方式均能改善患者视力、减轻黄斑水肿及优化视网膜血流参数，但巩膜后注射在各项疗效指标上的改善幅度最为显著。相比之下，球周注射与玻璃体腔注射虽然也显示出治疗效果，但其改善程度相对有限，且并发症发生率更高。因此，巩膜后注射可能是治疗RVO-ME的更优选择。

METHODS: From June 2021 to September 2024, patients with RVO-ME admitted to our hospital were assigned to three groups: group A(posterior scleral injection), group B(peripupillary injection), and group C(intravitreal injection). At 3 mo after treatment, the efficacy, best corrected visual acuity(BCVA LogMAR), central macular thickness(CMT), central retinal artery blood flow parameters, and incidence of complications were compared among the three groups of patients.

RESULTS: A total of 93 cases(93 eyes)of RVO-ME were included, with 31 cases(31 eyes)in each group. The mean age in the group A was 50.37±5.71 years old, with 15 males and 16 females, the group B was 48.92±5.36 years old, with 14 males and 17 females, and the group C was 49.66±5.54 years old, with 18 males and 13 females. The overall efficacy rate in the group A(94%)was higher than that in the groups B and C(68% and 74%), and the complication rate(6%)was lower than in the groups B and C(29% and 32%; P<0.05). At 1 and 3 mo after treatment, the BCVA of group A was 0.46±0.06, 0.36±0.04, the end diastolic velocity(EDV)was 11.45±1.79, 13.97±2.28 cm/s, and the peak systolic velocity(PSV)was 2.16±0.31, 2.83±0.42 cm/s; the BCVA of group B was 0.55±0.07, 0.46±0.05, EDV was 9.57±1.38, 12.03±2.14 cm/s, and PSV was 1.93±0.26, 2.41±0.39 cm/s. The BCVA of group C was 0.57±0.09, 0.48±0.06, EDV was 9.39±1.25, 11.91±2.06 cm/s, PSV was 1.87±0.24, 2.35±0.36 cm/s. The BCVA in the group A was better than that of the groups B and C, and EDV and PSV in the group A were greater than those of the groups B and C(all P<0.05); at 1 and 3 mo after treatment, the CMT of patients in the group A was 249.62±29.33 and 141.13±21.59 μm, and resistance index(RI)was 0.71±0.08 and 0.70±0.08, patients in the group B had CMT of 307.13±34.86 and 227.99±28.43 μm, and RI of 0.77±0.09 and 0.76±0.09, while patients in the group C had CMT of 311.42±40.66 and 232.56±31.44 μm, and RI of 0.79±0.11 and 0.78±0.10, with CMT and RI significantly lower in the group A than those in the groups B and C(all P<0.05).

CONCLUSION: All three methods improved visual acuity, reduced macular edema, and optimized retinal blood flow parameters. However, posterior scleral injection demonstrated the most significant improvement across all efficacy metrics. In contrast, although peripupillary injection and intravitreal injection demonstrated therapeutic effects, their improvements were relatively limited, and both had a higher incidence of complications. Therefore, posterior scleral injection may represent a superior treatment for RVO-ME.