查看更多>>摘要：目的 观察康柏西普玻璃体腔注射治疗湿性年龄相关性黄斑变性（wAMD）的临床疗效及安全性，探讨影响其预后的相关因素。 方法 回顾性研究。对61例wAMD患者（65只眼），按照连续三次每月注射后改用按需治疗方案（3+PRN）的原则给予玻璃体腔每次注射0.5 mg/0.05 ml康柏西普治疗。患者治疗后第1、2、3、6、12个月行最佳矫正视力（BCVA）及OCT检查，对比治疗前后BCVA和黄斑中心凹视网膜厚度（CRT）的变化，随访1年后BCVA、CRT、SRF、IRF、SHRM、PED、EZ及其相关性。依据患者末次随诊时的BCVA差值和基线BCVA的差值（Log MAR）将患者划分为两组：视力提高组和视力下降组。分析患者治疗前后的视力变化，并筛选出影响患者视力预后不佳的相关因素。 结果 治疗后第1、2、3、6、12个月后的BCVA提高、下降。基线期视网膜下积液（SRF）及视网膜下高反射信号物质（SHRM）特征影响治疗3个月及1年后的BCVA变化，差异有统计学意义（P <0.05），视网膜色素上皮脱离（PED）特征与CRT的恢复具有相关性，且椭圆体带（EZ）的断裂提示视力预后不佳的可能。视网膜层间积液（IRF）与患者视力预后无明显相关性。随访期间未见与治疗相关的眼部并发症和全身不良反应发生。 结论 玻璃体腔注射康柏西普治疗wAMD可有效提升患者的视力、降低黄斑中心凹厚度，使黄斑区结构得以改善和恢复，远期效果较好，且没有增加治疗风险。SRF、SHRM、PED、EZ可作为综合评价抗VEGF治疗后疗效的重要指标。 Objective To observe the clinical efficacy and safety of Conbercept Ophthalmic Injection in the treatment of wet age-related macular degeneration(wAMD), and to explore the relevant factors that affect its prognosis. Methods The data of 61 patients(65 eyes)with wAMD were retrospectively collected, and they received the 3 + PRN intravitreal treatments of Conbercept 0.5 mg/0.05ml. The best corrected visual acuity(BCVA)and OCT were performed at 1, 2, 3, 6 and 12 months after the treatment. The data of BCVA and central retinal thickness(CRT), before and after treatment were compared. The BCVA, CRT, subretinal fluid(SRF), intraretinal fluid(IRF), subretinal hyperreflective material(SHRM), retinal pigment epithelial detachment(PED), ellipsoidal zone(EZ)were analyzed. Patients were divided into two groups based on the Log MAR difference between the final follow-up BCVA and baseline BCVA:the vision improvement group and the vision loss group. the changes in vision before and after treatment, and the factors associated with poor vision prognosis were screened. Results BCVA increased and CRT decreased of 1, 2, 3, 6, 12 months after treatment. The characteristics of SRF and SHRM at baseline affected the changes in BCVA after 3 months and 1 year after treatment, and the difference was statistically significant(P <0.05). PED characteristics were correlated with the recovery of CRT, and the fracture of EZ indicated the possibility of poor vision prognosis, but IRF not. No treatment-related ocular complications and systemic adverse reactions occurred during the follow-up period. Conclusions Intravitreal injection of Conbercept for wAMD can effectively improve patients' vision, reduce macular fovea thickness, and it can improve and restore macular structure. The long-term effect is good without increasing treatment risks. SRF, SHRM, PED and EZ can be used as important indicators for comprehensive evaluation of the efficacy of anti-VEGF treatment.
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