目的：探讨光学相干断层扫描(OCT)影像学特征预测玻璃体腔注射康柏西普治疗糖尿病性黄斑水肿(DME)患者预后的价值。

方法：回顾性选择2021年7月至2024年8月在我院行玻璃体腔注射康柏西普治疗的DME患者，所有患者均玻璃体腔注射康柏西普每月1次，连续治疗3 mo。治疗后第4 mo行OCT及最佳矫正视力(BCVA)检查，以治疗后第4 mo BCVA变化作为主要疗效评价指标，将视力提高2行及以上者纳入预后良好组，小于2行者纳入预后不良组。收集两组患者的临床资料及OCT相关影像学特征，分析影响康柏西普治疗DME患者预后不良的因素及OCT相关影像学特征对治疗效果的预测价值。

结果：本研究共纳入DME患者115例115眼(若为双眼DME，仅纳入CMT较高者)，治疗后第4 mo 预后良好组78例78眼，其中男45例，女33例，平均年龄60.57±7.46岁，预后不良组37例37眼，其中男24例，女13例，平均年龄59.36±8.72岁，预后不良率为32.2%。预后不良组治疗前BCVA和CMT均高于预后良好组(均P<0.05)。预后不良组ELM完整性破坏、EZ完整性破坏和视网膜内层结构紊乱患眼占比均高于预后良好组(均P<0.05)。治疗前CMT(OR=1.030，P<0.001)、ELM完整性破坏(OR=22.475，P=0.002)、EZ完整性破坏(OR=23.584，P=0.001)、视网膜内层结构紊乱(OR=7.901，P=0.016)均是影响康柏西普治疗DME患者预后的因素。ELM完整性破坏、EZ完整性破坏、视网膜内层结构紊乱各指标单独及联合预测康柏西普治疗DME患者预后不良的AUC值分别为0.699、0.653、0.637和0.843。

结论：临床上DME患者应重视OCT检查，在早期通过识别高危影像学特征，判断DME患者的预后，为个体化治疗方案的制定提供客观依据。

METHODS: A retrospective selection was made of patients with DME who underwent intravitreal injection of conbercept at the hospital from July 2021 to August 2024. All patients received intravitreal injection of conbercept once a month for a total of 3 mo. OCT and best corrected visual acuity(BCVA)examinations were conducted at 4 mo after the treatment. The change in BCVA at 4 mo post-treatment served as the primary efficacy evaluation metric, with patients achieving a 2-line or greater improvement classified into the favorable prognosis group, while those with less than a 2-line improvement were categorized into the unfavorable prognosis group. Clinical data and OCT-related imaging features of the two groups were collected, and the factors influencing the unfavorable prognosis of patients treated with conbercept for DME and the predictive value of OCT-related imaging features for treatment efficacy were analyzed.

RESULTS:A total of 115 DME patients(115 eyes)were included in this study \〖for patients with bilateral DME, only the eye with greater central macular thickness(CMT)was included\〗. After 4 mo of treatment, 78 cases(78 eyes)were in the good prognosis group, including 45 males and 33 females, with an average age of 60.57±7.46 y. There were 37 cases(37 eyes)in the poor prognosis group, including 24 males and 13 females, with an average age of 59.36±8.72 y. The poor prognosis rate was 32.2%. The BCVA and CMT before treatment in the poor prognosis group were higher than those in the good prognosis group(all P<0.05). The proportions of ELM integrity destruction, EZ integrity destruction, and retinal inner layer structure disorder in the poor prognosis group were all higher than those in the good prognosis group(all P<0.05). The factors influencing the prognosis of DME patients treated with conbercept were pre-treatment CMT(OR=1.030, P<0.001), ELM integrity destruction(OR=22.475, P=0.002), EZ integrity destruction(OR=23.584, P=0.001), and retinal inner layer structure disorder(OR=7.901, P=0.016). The AUC values for predicting poor prognosis of DME patients treated with conbercept by each of the indicators of ELM integrity destruction, EZ integrity destruction, and retinal inner layer structure disorder alone and in combination were 0.699, 0.653, 0.637, and 0.843, respectively.

CONCLUSION: Clinically, OCT examination should be emphasized in patients with DME. In the early stage, by identifying high-risk imaging features, the prognosis of DME patients can be evaluated, providing objective evidence for the formulation of individualized treatment plans.