贝伐单抗治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿的短期疗效及影响因素分析

目的　观察玻璃体内注射贝伐单抗治疗视网膜中央静脉阻塞（central retinal vein occlusion，CRVO）继发黄斑水肿患者的临床特征及疗效，探讨对短期黄斑水肿恢复有影响的因素。方法　回顾性分析60例60眼CRVO继发黄斑水肿患者，采用玻璃体内注射贝伐单抗1.25 mg（0.05 mL），必要时重复治疗，随访3个月观察患者最佳矫正视力（best-corrected visual acuity，BCVA）及黄斑中心视网膜厚度（central retinal thickness，CRT）改变。根据治疗后3个月时CRT恢复水平，分析患者的年龄、病程、基线视力、基线CRT、高血压及糖尿病、黄斑囊样水肿（cystoid macular edema，CME）或视网膜下液体（subretinal fluid，SRF）情况对黄斑水肿恢复的影响。结果　BCVA从基线（0.897±0.395）LogMAR提高到治疗后1个月的（0.616±0.350）LogMAR，并稳定持续至治疗后3个月（P＜0.001），同时CRT从基线（721.2±180.8）μm降低到治疗后3个月的（392.1±185.4）μm（P＜0.001）。治疗后3个月56.7%的CME和超过90%的SRF均得到完全缓解。年龄和基线CRT低提示治疗后3个月时CRT恢复较好（P=0.036、0.037）。年龄大的患者（＞60岁）治疗后黄斑水肿消除更多（P=0.031），治疗后3个月时CRT更低（P=0.003）。结论　玻璃体内注射贝伐单抗能有效提高BCVA并降低CRT。年龄大和基线CRT低提示治疗后3个月时CRT恢复较好。CRT的降低主要取决于CME是否消除，而与SRF无关。

Analysis of short-term outcomes and factors for intravitreal bevacizumab in the treatment of macular edema secondary to central retinal vein occlusion

Objective　To investigate the clinical effects and the influence factors for short-term central retinal thickness （CRT） outcomes after intravitreal bevacizumab in patients with macular edema （ME） secondary to central retinal vein occlusion（CRVO）.Methods　Retrospective study was conducted in 60 eyes treated with intravitreal bevacizumab 1.25 mg （0.05 mL） for ME due to CRVO.Follow up was three months and additional injections were given for recurrent or persistent ME.Best corrected visual acuity （BCVA） and CRT were used to observe the changes after treatment.According to treatment response at 3 months based on CRT，baseline BCVA，CRT，age，CRVO duration，hypertension or diabetes mellitus，and the presence of cystoid macular edma（CME） or subretinal fluid（SRF） were analyzed for influence factors.Results　BCVA improved from （0.897±0.395）LogMAR at baseline to （0.616±0.350）LogMAR at 1 month and remained stable at 3 months，associated with a significant reduction in CRT from （721.2±180.8）μm to （392.1±185.4）μm （P＜0.001） after 3 months.About 56.7% of CME and more than 90% of SRF responded to treatment with a complete resolution at 3 months.Age （P=0.036） and low baseline CRT （P=0.037） were associated with a good 3 month prognosis.Patients＞60 years old achieved better CME resolution（P=0.031） and lower CRT （P=0.003） at 3 months.Conclusion　Intravitreal bevacizumab can significantly improve visual acuity and decreased CRT in patients with CRVO.Older age and lower baseline CRT maybe are the good predictors of short-term CRT outcomes.The retinal thickness response to bevacizumab depends on the resolution of CME，rather than SRF.