目的：明确视网膜分支静脉阻塞（BRVO）导致黄斑水肿的患者首次抗血管内皮生长因子（VEGF）治疗24 h后黄斑区视网膜厚度的变化是否与治疗应答相关，并分析可以预测患者长期治疗效果的阈值。方法：回顾性系列病例研究。收集2014年12月至2016年12月于哈尔滨医科大学附属第二医院眼科门诊明确诊断为BRVO且采用0.5 mg雷珠单抗玻璃体腔首次注射+PRN治疗方案的患者276例。记录注射前，注射后24 h、4～48周（每4周1次）视网膜水肿情况（光学相干断层扫描），各观察时间点最佳矫正视力（BCVA，ETDRS视力表），通过受试者工作特征（ROC）曲线确定预测48周能否治愈的阈值，采用Pearson相关性分析及多因素Logistic回归分析确定影响治疗效果的因素。结果：所有符合条件的60例BRVO患者（60眼）在注射后各时间点中央黄斑厚度（CMT）均有显著下降，BCVA明显提高。首次注射后24 h CMT下降值与48周CMT下降值显著相关（r=0.664，P<0.001），与48周时视力变化显著相关（r=0.642，P<0.001）。ROC曲线分析显示，24 h CMT下降达18%对预后判断最具敏感性及特异性，按此阈值将入组患者分为2组：A组为CMT在24 h下降小于18%（24例）；B组为下降超过 18%（36例）。Logistic回归分析分组（<18%）是治愈的预测因子（OR：19.549，95%CI：4.324～88.378， P<0.01），48周内视力提高分别为（13±11）字母、（19±14）字母，2组差异有统计学意义（t=-1.375， P<0.001）。结论：BRVO导致黄斑水肿患者的抗VEGF长期治疗效果与早期视网膜厚度变化相关，首次治疗后24 h CMT下降幅度超过18%者长期治疗效果好。
Objective: To identify the relationship between the early changes in central macular thickness (CMT) 24 hours after initial anti-vascular endothelial growth factor (VEGF) injection and the long-term therapeutic effect; to determine the threshold of the long-term prognosis by measuring the receiver operating characteristic (ROC) curve in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Method: This was a retrospective series of consecutive cases conducted to recruit 276 BRVO patients from December 2014 to December 2016 in the ophthalmic outpatient department of the Second Affiliated Hospital of Harbin Medical University. CMT was measured by OCT before injection, 24 hours after injection, and every 4 weeks up to 48 weeks. The best corrected visual acuity (BCVA) was measured by the ETDRS visual acuity scale. The threshold of the treatment effect at 48 weeks was determined by an ROC curve. Pearson correlation analysis and logistic regression analysis were used to identify the factors that might affect the treatment outcome. Results: All 60 eligible BRVO patients (60 eyes) showed a significant decrease in CMT at each time point after injection and BCVA increased significantly. The decrease in CMT at 24 hours after the first injection was significantly correlated with both the decrease in CMT at 48 weeks (r=0.664, P<0.001), and the change in visual acuity at 48 weeks (r=0.642, P<0.001). ROC curve analysis showed that the 18% decrease in CMT at 24 hours was the most sensitive and specific. According to this threshold, the patients were divided into two groups: 24 cases in group A decreased less than 18% at 24 hours and 36 cases in group B decreased more than 18%. The logistic regression analysis group (<18%) was a positive predictor of cure (OR: 19.549, 95%CI: 4.324-88.378, P<0.01). The improvement in visual acuity was 13±11 and 19±14 letters, respectively, and the difference was statistically significant (t=-1.375, P<0.001). Conclusion: The long-term therapeutic effect of ME secondary to BRVO in patients is correlated with the decline in CMT 24 hours after the first anti-VEGF injection using OCT, the decrease more than 18% predicts a good the long-term therapeutic effect.
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