目的：比较康柏西普3+按需治疗(PRN)与5+PRN方案治疗缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床疗效。

方法：采用回顾性队列研究设计，选取2021年6月至2024年3月我院收治的缺血型BRVO继发黄斑水肿患者，按治疗方案分为3+PRN组和5+PRN组。两组均接受玻璃体腔注射康柏西普(每次0.5 mg)，3+PRN组行3次初始强化注射后按需治疗，5+PRN组行5次初始强化注射后按需治疗，强化阶段两次注射间隔时间为1 mo。观察两组患者治疗前，治疗1、3、6、12 mo的最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、黄斑平均光敏感度(MS)，注射次数及不良反应情况。

结果： 本研究共纳入患者97例97眼，3+PRN组49例49眼中男26例，女23例，平均年龄58.61±8.67岁； 5+PRN组48例48眼中男23例，女25例，平均年龄59.18±8.54岁(均P>0.05)。两组患者治疗前后BCVA和MS组间比较均无差异(均P>0.05)； 治疗6、12 mo 5+PRN组患者CRT均小于3+PRN组(均P<0.05)； 各组患者治疗后BCVA、CRT、MS均较治疗前改善(均P<0.05)。5+PRN组全程总注射次数(6.24±0.94次)与3+PRN组(6.41±0.88次)比较无差异(P>0.05)。两组患者随访期间不良反应发生率比较无差异(10% vs 13%，P=0.721)。

结论：康柏西普3+PRN与5+PRN方案治疗缺血型BRVO继发黄斑水肿均安全有效； 5+PRN方案呈现“前期强化注射多、后期按需注射少”的特征，3+PRN方案呈现“前期强化注射少、后期按需注射多”的特征； 两种方案在长期视功能改善方面疗效相当，5+PRN方案在黄斑水肿消退方面更具优势。

METHODS: A retrospective cohort study design was adopted. Patients with macular edema secondary to ischemic BRVO admitted to our hospital from June 2021 to March 2024 were selected and divided into the 3+PRN group and the 5+PRN group. Both groups received intravitreal injections of Conbercept(0.5 mg per dose). The 3+PRN group received three consecutive monthly loading injections followed by PRN treatment, while the 5+PRN group received five consecutive monthly loading injections followed by PRN treatment. The best-corrected visual acuity(BCVA), central foveal retinal thickness(CRT), mean macular sensitivity(MS), number of injections, and adverse reactions were observed before treatment and at 1, 3, 6, and 12 mo after treatment in both groups.

RESULTS:Totally 97 patients(97 eyes)were included. There were 49 cases(49 eyes)in 3+PRN group(26 males and 23 females, aged 58.61±8.67 y)and 48 cases(48 eyes)in 5+PRN group(23 males and 25 females, aged 59.18±8.54 y)(all P>0.05). There was no significant difference in BCVA and MS between the two groups before and after treatment(all P>0.05). CRT in 5+PRN group was smaller than that in 3+PRN group at 6 and 12 mo after treatment(all P<0.05). BCVA, CRT, and MS were improved after treatment compared with before treatment in both groups(all P<0.05). There was no significant difference in the total number of injections during the whole follow-up between the 5+PRN group(6.24±0.94 injections)and the 3+PRN group(6.41±0.88 injections)(P>0.05). There was no significant difference in the incidence of adverse reactions between the two groups during follow-up(10% vs 13%, P=0.721).

CONCLUSION: Both the Conbercept 3+PRN and 5+PRN regimens are safe and effective for treating macular edema secondary to ischemic BRVO. The 5+PRN regimen is characterized by “more injections in the early loading phase and fewer injections in the later PRN phase”, while the 3+PRN regimen features “fewer injections in the early loading phase and more injections in the later PRN phase”. The two regimens show comparable efficacy in long-term visual function improvement, while the 5+PRN regimen has greater advantages in macular edema resolution.