The Clinical Observation Of Conbercept Treatment Of Macular Edema Secondary To Retinal Vein Occlusion And Analysis Of Predictive And/or Prognostic Value Of Baseline Parameters For Visual Recovery

Objective:By comparing the changes of various observation indicators before and after treatment of RVO-ME patients with intravitreal injection of Conbercept,clinical observations of the efficacy were analyzed,and whether the relevant indicators could be used as predictors of visual recovery and macular edema recurrence,on the basis of which,a clinical predictive model for the prognosis of vision was proposed.Methods:A retrospective analysis was performed on the patients with RVO-ME who had been treated with intravitreal injection of Conbercept from February 2017 to November 2019 in the Ophthalmology Center Ophthalmology Center of the Second Hospital of Jilin University.108 cases(108 eyes)were identified and excluded based on the criteria.All patients received as-needed(1 + PRN)after the first injection,and during the course of treatment they were injected with Conbercept 0.5mg/0.05 ml by the same surgeon.We recorded the patient's various data before and after treatment(e.g.1m,3m,6m,12 m and the end),such as the best corrected visual acuity(BCVA),central retinal thickness(CRT),the number of inner and outer retina hyperreflective foci(HF),the integrity of the external limiting membrane(ELM),the integrity of ellipsoid zone(EZ)and the presence or absence of subretinal fluid(SRF)were analyzed.Patients with terminal BCVA?0.5 after treatment were included in the group named good vision,and patients with terminal BCVA<0.5 were included in the group named poor vision,and related indicators of visual prognosis were analyzed.Patients who received additional PRN injections in the last 3 months before the end of treatment were included in the recurrence group,and patients who had not received additional PRN injections were included in the resolved group for analysis of related indicators of macular edema recurrence.A logistic clinical predictive model for the terminal vision prognosis was established and performance evaluation was performed.Data analysis was performed using SPSS 26.0.Results:Efficacy analysis showed that BCVA,CRT,numbers of outer and inner retinal hyperreflective foci and presence of subretinal fluid compared before and after treatment were significantly decreased(P<0.001).The differences between the BRVO and CRVO groups over time had no difference.The initial observation indicators were significantly more severe than those at 1,3,6,12 months and end after treatment(P <0.0001).Neither ocular nor systemic severe adverse events were observed in all patients during the follow-up.Univariate analysis showed that factors associated with visual outcome included duration of onset(t = 24.259,P<0.0001),number of injections(t = 10.541,P<0.002),baseline BCVA(t = 5.167,P = 0.028),and baseline CRT(t = 4.084,P = 0.049),external membrane continuity(t = 8.396,P = 0.004),ellipsoidal band integrity(t = 4.120,P = 0.042),and presence of SRF(t = 4.308,P = 0.038).Multivariate analysis found that the baseline BCVA(P = 0.007)and the presence of SRF(P = 0.012)can be used as indicators to predict the final visual prognosis.Baseline BCVA(P = 0.028)and baseline CRT(P = 0.007)could be used as indicators to predict the recurrence of macular edema.The clinical predictive model established with the baseline BCVA and SRF as predictors had a calibration degree of 0.116,an AUC value of 0.864(95% CI: 0.747-0.982),and the best cutoff value for predicting good terminal vision was 0.695,sensitivity was 0.958 and specificity was 0.737.After adding the onset duration,baseline CRT,ELM continuity,and EZ integrity,the AUC values of the multiple improved clinical prediction models established were 0.890(95% CI: 0.783-0.998)and 0.851(95% CI: 0.731-0.971),0.855(95% CI: 0.735-0.975),and 0.866(95% CI: 0.757-0.975).The best cutoffs for predicting terminal vision were 0.759,0.612,0.623,and 0.592,respectively.Conclusion:1.Conbercept can effectively improve the vision of RVO patients,resolve macular edema,and have good safety in the short term.2.Duration of onset,baseline BCVA,baseline CRT,external membrane continuity,ellipsoidal band integrity,and the presence of SRF can be used as predictors of visual outcome prognosis of RVO-ME in the treatment of Conbercept.3.Baseline BCVA and baseline CRT are factors that affect the recurrence of macular edema in RVO patients.4.The clinical predictive model based on baseline BCVA,the presence of SRF and ellipsoidal band integrity as predictors is valuable for visual prognosis of RVO patients received Conbercept injection.