SD-OCT联合mf-ERG对康柏西普单次治疗nAMD的效果评价

Evaluation of the efficacy of conbercept in single treatment of nAMD by SD-OCT in combination with mf-ERG

摘要:

目的：观察单次玻璃体腔注射康柏西普治疗渗出型年龄相关性黄斑变性（neovascular age-related macular degeneration，nAMD），通过光学相干断层扫描（spectral-domain optical coherence tomography，SD-OCT）及多焦视网膜电图（multifocal elec－troretinogram，mf-ERG）了解视网膜解剖与视网膜功能的相关性，评价康柏西普治疗nAMD的短期疗效，探讨mf-ERG作为预测疗效及优化治疗方案的价值。方法：回顾性收集nAMD患者36例36只眼，均接受玻璃体腔注射康柏西普0.05 mL/0.5 mg一次的治疗，记录治疗前及治疗后1个月时的最佳矫正视力（best corrected visual acuity，BCVA）、视网膜黄斑中央厚度（central retinal macular thickness，CRT）、以黄斑为中心1、3、6 mm圆内RPE隆起的容积（1RV、3RV、6RV），mf-ERG中R1环P1波振幅密度、潜伏期等数据资料。统计学分析采用SPSS 22.0软件，2组计量资料的差异比较采用两配对样本t检验，采用Pearson相关性分析评价黄斑区功能与结构的相关性，检验水准α=0.05。结果：36例36只眼经康柏西普治疗后较治疗前，平均BCVA提高（0.19±0.16 vs. 0.26±0.17）；平均CRT下降[（472.14±181.53） μm vs. （389.5±124.79） μm]；平均1RV下降[（0.36±0.14） mm3 vs. （0.31±0.11） mm3]；平均3RV下降[（3.04±0.98） mm3 vs. （2.59±0.71） mm3]，平均6RV下降[（8.17±2.91） mm3 vs. （6.66±2.38） mm3]，差异均有统计学意义（P＜0.01）。P1波振幅密度与治疗前的（36.47±14.25） nv/deg2相比，增加至（47.21±13.13） nv/deg2，差异有统计学意义（P＜0.01），P1波潜伏期相比无明显改变[（38.13±9.75） ms vs. （39.21±9.62） ms]，差异无统计学意义（P＞0.05）。术前术后BCVA与CRT、1RV、3RV、6RV均呈显著负相关，与P1波振幅密度、潜伏期均呈显著正相关；术前术后CRT、3RV、6RV与P1波振幅密度均呈显著负相关，差异有统计学意义（P＜0.05）。3例3只眼在注射后出现结膜下出血，治疗后均恢复正常，所有患者随访期间未见严重眼部及全身并发症。结论：康柏西普治疗nAMD短期疗效确切，可提高患眼视力，恢复视网膜结构与功能，安全性高；BCVA、SD-OCT联合mf-ERG对于评价nAMD治疗效果更客观、更全面，mf-ERG有望成为nAMD治疗过程中评估疗效和判断再治疗的客观功能学指标。

Abstract:

Objective：To observe the effect of a single intravitreal injection of conbercept in the treatment of neovascular age-related macular degeneration（nAMD），to evaluate the short-term efficacy of conbercept in the treatment of nAMD through investigating the correlation between retinal anatomy and retinal function by spectral-domain optical coherence tomography（SD-OCT） and multifocal electroretinogram（mf-ERG），and to explore the value of mf-ERG in predicting therapeutic effect and optimizing therapeutic regimen. Methods：A retrospective analysis was conducted in 36 patients with nAMD（36 eyes）. All patients were treated with a single intravit－real injection of conbercept 0.05 mL/0.5 mg. The best corrected visual acuity（BCVA），the central retinal macular thickness（CRT），the volume of RPE uplift in the 1，3，and 6 mm circles with the macula lutea as the center（1RV，3RV，6RV），and the amplitude density and latency of P1 wave in mf-ERG R1 ring were recorded before and at 1 month after treatment. Statistical analysis was performed using SPSS 22.0 software. Continuous data were compared between two groups using the paired t-test，and the correlation between macular structure and function was evaluated by Pearson cor－relation analysis，with a test level of 0.05. Results：After treat－ment with conbercept in the 36 eyes of 36 patients，the mean BCVA significantly improved（0.19±0.16 vs. 0.26±0.17），the mean CRT significantly decreased[（472.14±181.53） μm vs. （389.5±124.79） μm]，the mean 1RV significantly decreased[（0.36±0.14） mm3 vs. （0.31±0.11） mm3]，the mean 3RV significantly decreased[（3.04±0.98） mm3 vs. （2.59±0.71） mm3]，and the mean 6RV significantly decreased[（8.17±2.91） mm3 vs. （6.66±2.38） mm3] （all P<0.01）. The amplitude density of P1 wave signifi－cantly increased from （36.47±14.25） nv/deg2 before treatment to （47.21±13.13） nv/deg2 after treatment（P<0.01），while the latency of P1 wave showed no significant change after treatment[（38.13±9.75） ms vs. （39.21±9.62） ms，P>0.05]. BCVA had a significant negative correlation with CRT，1RV，3RV，and 6RV before and after operation，but a significant positive correlation with the amplitude density and latency of P1 wave；CRT，3RV and 6RV were significantly negatively correlated with the amplitude density of P1 wave before and after operation（P<0.05）. Subconjunctival hemorrhage occurred in 3 eyes of 3 patients after injection，and all recovered after treatment. No serious ocular and systemic complications were noticed in any of the patients during follow-up. Conclusion：Conbercept has definite short-term efficacy in the treatment of nAMD，which can improve the visual acuity of the affected eyes，and restore the structure and function of the retina with a high safety. BCVA and SD-OCT combined with mf-ERG are more objective and compre－hensive in evaluating the treatment outcome of nAMD，and mf-ERG is expected to be an objective functional indicator for evalu－ating the efficacy and judging the re-treatment during the treatment of nAMD.