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中华眼科医学杂志(电子版) ›› 2025, Vol. 15 ›› Issue (04) : 220 -225. doi: 10.3877/cma.j.issn.2095-2007.2025.04.005

论著

影响视网膜静脉阻塞伴黄斑水肿治疗效果因素的临床研究
耿超1, 董立红1,†(), 俞华1, 刘俊2   
  1. 1238000　合肥，安徽医科大学第四附属医院眼科
    2230000　合肥市第三人民医院眼科
  • 收稿日期:2025-06-16 出版日期:2025-08-28
  • 通信作者: 董立红
  • 基金资助:
    安徽省转化医学研究院科研基金项目(2021zhyx-C57，2023zhyx-C96)

The influencing factors in the treatment of retinal vein occlusion complicated with macular edema

Chao Geng1, Lihong Dong1,†(), Hua Yu1, Jun Liu2   

  1. 1Department of Ophthalmology, the Fourth Affiliated Hospital of Anhui Medical University, Hefei 238000, China
    2Department of Ophthalmology, Hefei Third People′s Hospital, Hefei 230000, China
  • Received:2025-06-16 Published:2025-08-28
  • Corresponding author: Lihong Dong
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引用本文：

耿超, 董立红, 俞华, 刘俊. 影响视网膜静脉阻塞伴黄斑水肿治疗效果因素的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2025, 15(04): 220-225.

Chao Geng, Lihong Dong, Hua Yu, Jun Liu. The influencing factors in the treatment of retinal vein occlusion complicated with macular edema[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2025, 15(04): 220-225.

目的

探讨影响视网膜静脉阻塞(RVO)伴黄斑水肿治疗的因素。

方法

选取2023年10月至2025年3月期间在安徽医科大学第四附属医院眼科接受3个月的抗血管内皮生长因子治疗RVO伴黄斑水肿患者30例(32只眼)作为研究对象。其中，男性20例(21只眼)，女性10例(11只眼)；年龄35~85岁，平均年龄(58.2±11.4)岁。使用扫频光源光学相干断层扫描血管成像技术(SS-OCTA)测量治疗前后的脉络膜厚度(CT)、脉络膜血管指数(CVI)以及脉络膜毛细血管层血流密度(CCVD)。治疗前、治疗后1个月及治疗后3个月的最佳矫正视力(BCVA)、眼压、中央黄斑厚度(CMT)、CT、CVI及CCVD符合正态分布，以±s表示，不同时间点的比较采用单因素重复测量方差分析，采用LSD法进行两两比较。以BCVA和CMT变化为因变量，基本资料为自变量，进行单因素线性回归分析和多元线性回归分析。

结果

本研究30例患者(32只眼)中，高血压和无高血压者分别为18例(20只眼)和12例(12只眼)，分别占62.50%和37.50%。患者治疗前、治疗后1个月及治疗后3个月的BCVA分别是(0.813±0.456)最小分辨视角的对数(logMAR)、(0.666±0.386)logMAR及(0.484±0.401)logMAR；眼压分别为(16.219±2.366)mmHg(1 mmHg＝0.133 kPa)、(15.969±1.732)mmHg及(16.500±2.514)mmHg；CMT分别为(474.625±191.370)μm、(397.094±155.446)μm及(360.219±173.240)μm；CT分别为(244.813±86.086)μm、(234.563±86.853)μm及(229.063±88.710)μm；CVI分别为(39.938±4.683)%、(39.375±5.552)%及(39.625±5.950)%；CCVD分别为(46.188±3.788)%、(46.813±2.361)%及(47.125±1.755)%，患者不同时间点BCVA、CMT及CT的比较，差异有统计学意义(F＝34.556，14.373，11.955；P<0.05)；眼压、CVI及CCVD的比较，差异无统计学意义(F＝0.959，0.979，1.610；P>0.05)。经LSD法两两比较，患者治疗后1个月的BCVA、CMT及CT较治疗前差异有统计学意义(t＝4.027，3.645，3.452；P<0.05)；眼压、CVI及CCVD较治疗前差异无统计学意义(t＝0.701，1.605，-1.177；P>0.05)。治疗后3个月的BCVA、CMT及CT较治疗前差异有统计学意义(t＝6.837，3.990，3.549；P<0.05)；眼压、CVI及CCVD较治疗前差异无统计学意义(t＝-0.722，0.583，-1.368；P>0.05)。所有患者治疗3个月后BCVA较治疗前提高0.329 logMAR；CMT相对治疗前减少24.1%。经单因素线性回归分析，高血压、治疗前CMT及治疗前CCVD是治疗后BCVA变化的影响因素(β＝0.328，-0.001, 0.027；95%CI：0.173~0.484，-0.001~0.000，0.003~0.050；P<0.05)；高血压、治疗前BCVA及治疗前CCVD是治疗后CMT变化的影响因素(β＝-0.226，0.235，-0.036；95%CI：-0.359~-0.092，0.095~0.376，-0.053~-0.019；P<0.05)。经多变量线性回归分析，高血压是RVO患者治疗后BCVA变化的独立危险因素(β＝0.269，95%CI：0.102~0.436；P<0.05)；治疗前BCVA和治疗前CCVD是治疗后CMT变化的影响因素(β＝0.155，-0.024；95%CI：0.029~0.280，-0.043~-0.006；P<0.05)。

结论

治疗前BCVA是其CMT变化的独立保护因素，治疗前CCVD是其CMT变化的独立危险因素。高血压可疑为RVO患者抗VEGF治疗后BCVA变化的独立危险因素。本研究病例数较少，有待扩大病例数量进一步验证。

关键词: 视网膜静脉阻塞, 超广角扫频光源光学相干断层扫描血管成像, 脉络膜厚度, 脉络膜血管指数, 脉络膜毛细血管层血流密度, 抗血管内皮生长因子
Objective

The aim of this study is to investigate the influencing factors in the treatment of retinal vein occlusion (RVO) complicated with macular edema.

Methods

A total of 30 patients (32 eyes) diagnosed with RVO complicated with macular edema in the Department of Ophthalmology, the Fourth Affiliated Hospital of Anhui Medical University from October 2023 to March 2025 received anti-vascular endothelial growth factor (anti-VEGF) treatment for 3 months, were selected as the research subjects. There were 20 males (21 eyes) and 10 females (11 eyes) with an average age of (58.2±11.4) years (ranging from 35 to 85 years) of the 30 patients (32 eyes). Swept-source optical coherence tomography angiography (SS-OCTA) was used to measure choroidal thickness (CT), choroidal vascular index (CVI), and choroidal capillary layer vessel density (CCVD) before and after treatment. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), CT, CVI, and CCVD before treatment, after treatment for 1 month and 3 months conformed to a normal distribution and were expressed as ±s. Comparisons among different time points were performed using ANOVA, and pairwise comparisons were conducted using LSD method. Univariate linear regression analysis and multivariate linear regression analysis was performed with changes in BCVA and CMT as dependent variables and basic data as independent variables.

Results

There were 18 patients (20 eyes) with hypertension, and 12 patients (12 eyes) with no hypertension, accouting for 62.50% and 37.50%, respectively. The BCVA of patients before treatment, after treatment for 1 month and 3 months after treatment was (0.813±0.456) logarithmus of the minimal angle of resolution (logMAR), (0.666±0.386) logMAR, and (0.484±0.401) logMAR, respectively; the IOP was (16.219±2.366)mmHg (1 mmHg=0.133 kPa), (15.969±1.732)mmHg, and (16.500±2.514)mmHg, respectively; the CMT was (474.625±191.370)μm, (397.094±155.446)μm, and (360.219±173.240)μm, respectively; the CT was (244.813±86.086)μm, (234.563±86.853)μm, and (229.063±88.710)μm, respectively; the CVI was (39.938±4.683)%, (39.375±5.552)%, and (39.625±5.950)%, respectively; the CCVD was (46.188±3.788)%, (46.813±2.361)%, and (47.125±1.755)%, respectively. Comparisons of BCVA, CMT, and CT among different time points showed statistically significant differences (F=34.556, 14.373, 11.955; P<0.05), while no statistically significant differences were observed in IOP, CVI, and CCVD (F=0.959, 0.979, 1.610; P> 0.05). Further pairwise comparisons revealed that after treatment for 1 month, BCVA, CMT, and CT of patients showed statistically significant differences compared with those before treatment (t= 4.027, 3.645, 3.452; P<0.05), whereas IOP, CVI, and CCVD exhibited no statistically significant differences (t=0.701, 1.605, -1.177; P> 0.05). After treatment for 3 months, BCVA, CMT, and CT were significantly different from those before treatment (t= 6.837, 3.990, 3.549; P<0.05), while no significant differences were found in IOP, CVI, and CCVD (t= -0.722, 0.583, -1.368; P> 0.05). After treatment for 3 months, the BCVA of all patients increased by 0.329 logMAR compared with that before treatment, and the CMT decreased by 24.1% relative to the pre-treatment level. Univariate linear regression analysis indicated that hypertension, pre-treatment CMT, and pre-treatment CCVD were influencing factors for the change in BCVA after anti-VEGF treatment for 3 months (β= 0.328, -0.001, 0.027; 95% confidence interval (CI): 0.173 to 0.484, -0.001 to 0.000, 0.003 to 0.050; P<0.05); hypertension, pre-treatment BCVA, and pre-treatment CCVD were influencing factors for the change in CMT after treatment for 3 months (β= -0.226, 0.235, -0.036; 95%CI: -0.359 to -0.092, 0.095 to 0.376, -0.053 to -0.019; P<0.05). Multivariate linear regression analysis showed that hypertension was an independent risk factor for the change in BCVA after anti-VEGF treatment in RVO patients (β= 0.269, 95%CI: 0.102 to 0.436; P<0.05); pre-treatment BCVA and pre-treatment CCVD were influencing factors for the change in CMT after treatment (β=0.155, -0.024; 95%CI: 0.029 to 0.280, -0.043 to -0.006; P<0.05).

Conclusions

Hypertension is an independent risk factor for the change in BCVA after anti-VEGF treatment in RVO patients. Pre-treatment BCVA is an independent protective factor for the change in CMT, and pre-treatment CCVD is an independent risk factor for the change in CMT.

Key words: Retinal vein occlusion, Ultra-widefield swept-source optical coherence tomography angiography, Choroidal thickness, Choroidal vascular index, vascular density of choriocapillaris, Anti-vascular endothelial growth factor
表1 视网膜静脉阻塞伴黄斑水肿患者治疗前后相关指标的变(±s)
指标 眼数(只眼) BCVA(logMAR) 眼压(mmHg) CMT(μm) CT (μm) CVI(%) CCVD(%)
治疗前 32 0.813±0.456 16.219±2.366 474.625±191.370 244.813±86.086 39.938±4.683 46.188±3.788
治疗后1个月 32 0.666±0.386a 15.969±1.732 397.094±155.446a 234.563±86.853a 39.375±5.552 46.813±2.361
治疗后3个月 32 0.484±0.401ab 16.500±2.514 360.219±173.240ab 229.063±88.710ab 39.625±5.950 47.125±1.755
F值   34.556 0.959 14.373 11.955 0.979 1.610
P值   <0.05 >0.05 <0.05 <0.05 >0.05 >0.05
表2 RVO伴黄斑水肿患者抗血管内皮生长因子治疗3个月后对BCVA变化影响因素的单因素和多因素线性回归分析结果
因素 β 95%CI P值
单因素      
年龄 -0.004 -0.011~0.004 >0.05
性别 -0.060 -0.260~0.140 >0.05
高血压 0.328 0.173~0.484 <0.05
眼别 0.034 -0.161~0.228 >0.05
RVO类型 -0.051 -0.251~0.150 >0.05
眼压 0.010 -0.031~0.051 >0.05
治疗前CMT -0.001 -0.001~0.000 <0.05
治疗前CT 0.000 -0.001~0.001 >0.05
治疗前CVI -0.004 -0.024~0.016 >0.05
治疗前CCVD 0.027 0.003~0.050 <0.05
多因素      
高血压 0.269 0.102~0.436 <0.05
治疗前CMT 0.000 -0.001~0.000 >0.05
治疗前CCVD 0.004 -0.017~0.026 >0.05
表3 RVO伴黄斑水肿患者抗血管内皮生长因子治疗3个月后对CMT变化影响因素的单因素和多因素线性回归分析结果
因素 β 95%CI P值
单因素      
年龄 0.005 -0.001~ 0.011 >0.05
性别 0.055 -0.103~ 0.213 >0.05
高血压 -0.226 -0.359~-0.092 <0.05
眼别 -0.087 -0.238~ 0.064 >0.05
RVO类型 0.116 -0.038~ 0.270 >0.05
眼压 0.002 -0.031~ 0.034 >0.05
治疗前BCVA 0.235 0.095~ 0.376 <0.05
治疗前CT 0.000 -0.001~ 0.000 >0.05
治疗前CVI -0.003 -0.019~ 0.013 >0.05
治疗前CCVD -0.036 -0.053~-0.019 <0.05
多因素      
高血压 -0.080 -0.217~ 0.057 >0.05
治疗前BCVA 0.155 0.029~ 0.280 <0.05
治疗前CCVD -0.024 -0.043~-0.006 <0.05
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