| Objective: To compare the clinical effect of conbercept combined with macular grid laser and conbercept alone in the treatment of macular edema(ME)secondary to retinal vein occlusion(RVO),and to investigate the factors affecting the visual prognosis of macular edema secondary to retinal vein occlusion.Methods: Prospective cohort study.A total of 53 patients with RVO-ME diagnosed in the first affiliated hospital of WanNan medical college from July 2018 to October 2019 were selected.They were divided into simple vitreous cavity injection of conbercept group and conbercept combined with macular grid laser photocoagulation group.Single injection group: In 18 patients with 18 eyes,0.05 ml of conbercept was injected into the vitreous cavity of this group,adopted 1+ PRN scheme.Combined group: 35 cases in 35 eyes.The combined group was divided into A group,B group,C group and D group according to the time interval of laser photocoagulation in the macular area after the injection of conbercept into the vitreous cavity.Group A: 12 patients with 12 eyes received laser photocoagulation 1 week after the vitreous cavity injection of conbercept.Group B: 11 patients with 11 eyes received laser photocoagulation 1 month after the vitreous cavity injection of conbercept.Group C: 6 patients with 6 eyes received laser photocoagulation 2 months after the vitreous cavity injection of conbercept.Group D: 6 patients with 6 eyes received laser photocoagulation 3 months after the vitreous cavity injection of conbercept.All patients were followed up for 1,2,3 and 6 months after the initial injection,and the best-corrected visual acuity(BCVA),subfoveal choroidal thickeness(SFCT)and thickness of central macula(CMT)of the patients were detected before treatment and after the initial injection for 1,2,3 and 6months.During the observation period,the patient was evaluated once a month,and if necessary,the patient received repeated injections into the vitreous cavity.The changes of BCVA,SFCT and CMT before and after treatment,as well as the differences in the number of times of vitreous injection of conbercept under different treatment plans were compared.SPSS 25.0 software was used for statistical analysis.Results: 1.Changes of various detection indexes in RVO-ME patients before and after treatment Simple drug group: The overall difference of BCVA at different time points in patients with RVO-ME treated with vitreous injection of conbercept was statistically significant(P < 0.05),before and after treatment 1,2,3 and 6 months respectively,two comparison,treatment 1,2,3 and 6 months after the visual acuity was increased,the difference was statistically significant(adjusted are P < 0.05),and each time point after treatment there was no statistically significant difference between visual acuity(P > 0.05)after adjusting.Risk of eye treatment at different time points of CMT overall comparison was statistically significant difference(P < 0.05),after treatment 1,2,3,6 months of CMT value was significantly decreased,the Bonferroni method is used to do further two comparison of each point in time after treatment 1,2,3,6 months before CMT and treatment CMT difference was statistically significant(P < 0.05).The overall difference of SFCT at different time points was statistically significant(P < 0.05),2,3 and 6months after treatment of SFCT was decreased significantly,the first month after treatment of SFCT range is not big,2,3 and 6 months after treatment before SFCT and treatment SFCT difference was statistically significant(adjusted are P < 0.05),after treatment 1 months before SFCT and treatment SFCT difference was not statistically significant(P > 0.05)after adjustment.Combined group: there was a statistically significant difference in BCVA at different time points before and after the vitreous cavity injection into the RVO-ME patients combined with the grid laser photocoagulation in macular area(P < 0.05).Further pairwise comparison at each time point showed that BCVA in the affected eyes increased 2 months after treatment and 6 months after treatment compared with before treatment,with statistically significant difference(all P<0.05 after adjustment),and no statistically significant difference in visual acuity at other time points(all P>0.05 after adjustment).The CMT values at 1,2,3 and 6 months after treatment were significantly lower than those before treatment,and the overall difference of CMT at different time points was statistically significant(P<0.05).Pairwise comparison at each time point before and after treatment showed statistically significant differences between 1,2,3and 6 months after treatment and before treatment(all P<0.05 after adjustment).Suffer from eye treatment 1,2,3,6 months after SFCT are lower than before treatment,at different time points SFCT overall comparison was statistically significant difference(P< 0.05),the two time points before and after the treatment,including 3,6 months after treatment compared with before treatment difference was statistically significant(adjusted are P < 0.05),1,2 months after treatment and there was no statistically significant difference before treatment(all P>0.05 after adjustment).The improvement of BCVA in the combined group at 1,3 and 6 months after treatment was significantly greater than that in the single injection group,and the overall difference was statistically significant(all P<0.05).The initial CMT of RVO-ME in the combined group was higher than that in the single injection group,and the overall difference was statistically significant(P<0.05).However,there was no statistically significant difference in the overall CMT at 1,2,3 and 6 months after treatment(P>0.05).There was no statistically significant difference between the two groups in the overall difference of SFCT at each time point of treatment(all P>0.05).There was nostatistically significant difference in the number of recurrent macular edema and the number of injection between the two groups(all P>0.05).2.Changes of various detection indicators before and after treatment in patients with RVO-ME in the combined group under different treatment regiments There was a statistically significant difference in the overall BCVA of RVO-ME patients in the combined treatment group at the 3rd month and the 6th month under different treatment regiments(all P<0.05).3 months after the vitreous cavity injection of conbercept,laser photocoagulation significantly increased the BCVA compared with 2months after the vitreous cavity injection of conbercept at 3 months after the treatment,and the difference was statistically significant(adjusted P<0.05).Laser photocoagulation 1 month after vitreous cavity injection significantly increased the BCVA at 6 months after treatment compared with 2 or 3 months after vitreous cavity injection,and the difference was statistically significant(all P<0.05 after adjustment).There was no statistically significant difference in the overall difference between CMT and SFCT at each time point under different protocols(all P>0.05).There was a statistically significant difference in the total number of times of drug administration in different treatment regiments(P<0.05).By pairwise comparison of different schemes,RVO-ME patients who received laser photocoagulation one week after drug injection had fewer times of drug injection than those who received laser photocoagulation three months after drug injection,and the difference was statistically significant(adjusted P<0.05).There was no statistically significant difference in the number of recurrent macular edema under different treatment schemes(P>0.05).3.Correlation between BCVA at 6 months after treatment in RVO-ME patients and the number of recurrent macular edema,number of injections,CMT,SFCT,logMAR BCVA before treatment,age,and time from onset to initial treatment CMT before and 3 months after treatment were positively correlated with logMAR BCVA at 6 months after treatment(rs=0.310,0.319,P<0.05).The decrease of CMT 1month after treatment was positively correlated with the decrease of CMT 6 months after treatment(rs=0.567 P<0.05).There was no correlation between SFCT before treatment and 1,2,3 months after treatment and logMAR BCVA at 6 months after treatment(rs=0.136,0.152,0.129,0.130,all P>0.05).There was a positive correlation between logMAR BCVA before treatment,the patient’s age,the number of macular edema recurrence and logMAR BCVA at the 6th month after treatment(rs=0.517,0.389,0.371,all P<0.05).There was no correlation between the number of injections and the time from onset to initial treatment and logMAR BCVA at 6 months after treatment(rs=0.102,0.189,P>0.05).Conclusion: 1.The effect of conbercept combined with macular grid laser in the treatment of RVO-ME is better than that of simple conbercept injection.2.One month after intravitreal injection of conbercept,grid laser photocoagulation in macular area was the best combination therapy.3.BCVA,CMT,age of the patient,and number of recurrence of macular edema are the influencing factors of vision prognosis in RVO-ME patients. |
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