目的：探讨雷珠单抗对缺血型与非缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)患者黄斑区不同区域血流密度的影响。

方法：回顾性研究。纳入2019年9月至2021年3月在我院就诊的BRVO继发ME患者，根据眼底情况分为缺血型和非缺血型组。所有患者均接受每月1次，连续3 mo的玻璃体腔注射雷珠单抗治疗。比较治疗前，首次注射后1 d，1 wk，1、3 mo(距第3次注射已间隔1 mo)最佳矫正视力(BCVA)、中心凹视网膜厚度(CMT)及黄斑区血流密度。

结果：本研究共纳入BRVO继发ME患者46例46眼，缺血型组21眼中男7例，女14例，平均年龄55.81±10.36 岁； 非缺血型组25眼中男11例，女14例，平均年龄54.84±9.81岁。治疗后3 mo，非缺血型组BCVA(LogMAR)优于缺血型组(0.19±0.19 vs 0.38±0.27， P=0.009)。对CMT变化量的分析显示，缺血型组在治疗后1、3 mo的下降幅度均显著大于非缺血型组(均P<0.05)。缺血型患者治疗后3 mo全区域SCP、旁中心凹区SCP、中心凹周围区SCP，以及全区域DCP、中心凹周围区DCP的血流密度显著低于非缺血型组，而黄斑中心凹区DCP血流密度则显著高于缺血型组(均P<0.05)。

结论：雷珠单抗治疗缺血型与非缺血型BRVO继发黄斑水肿ME患者均有效，非缺血型患者远期视力预后更佳，其优势可能与治疗后3 mo特定区域更优的血流灌注模式有关。监测这些区域的血流密度变化有助于为患者提供个体化治疗。

METHODS:This retrospective study enrolled patients with BRVO-ME who were treated at the hospital from September 2019 to March 2021. Patients were divided into ischemic and non-ischemic groups based on fundus findings. All patients received intravitreal injections of ranibizumab once monthly for three consecutive months. Best corrected visual acuity(BCVA), central macular thickness(CMT), and macular blood flow density were measured before treatment and at 1 d, 1 wk, 1 and 3 mo after treatment.

RESULTS: A total of 46 patients(46 eyes)with BRVO-ME were included, comprising 21 eyes in the ischemic group(7 males, 14 females; mean age 55.81±10.36 y)and 25 eyes in the non-ischemic group(11 males, 14 females; mean age 54.84±9.81 y). At 3 mo after treatment, BCVA(LogMAR)in the non-ischemic group was superior to that in the ischemic group(0.19±0.19 vs 0.38±0.27, P=0.009). Analysis of CMT changes showed that the reduction amplitude in the ischemic group was significantly greater than that in the non-ischemic group at both 1 and 3 mo after treatment(all P<0.05). Blood flow densities in the whole, parafoveal, and perifoveal regions of the superficial capillary plexus(SCP), as well as in the whole and perifoveal regions of the deep capillary plexus(DCP), were significantly lower in ischemic patients than in non-ischemic patients, while blood flow density in the foveal region of DCP was significantly higher in the ischemic group(all P<0.05).

CONCLUSION: Ranibizumab is effective for both types of patients. Non-ischemic patients have a better long-term visual prognosis, and the advantage may be related to better blood flow perfusion patterns in specific areas 3 mo after treatment. Monitoring changes in blood flow density in these areas can help provide personalized treatment for patients.