目的：探讨玻璃体黄斑粘连(VMA)对视网膜分支静脉阻塞(BRVO)患者抗VEGF治疗的影响。

方法：回顾性病例研究。选取2017-01/2019-05在我院眼科接受玻璃体腔注射康柏西普治疗的BRVO伴黄斑水肿患者110例110眼，根据初诊时OCT特征，将纳入患者分为存在VMA组(VMA+组，34眼)和无VMA组(VMA-组，76眼)。首次注药后至少定期随访6mo，记录注射次数，检测两组患者最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)，根据OCT扫描结果评估玻璃体黄斑粘附状态及黄斑部玻璃体后脱离(PVD)发生情况。

结果：随访至首次注药后6mo，VMA+组和VMA-组患者平均玻璃体腔注射次数无差异(2.91±1.05次 vs 3.08±1.22次，P=0.915)。首次注药后第6mo时，两组患者BCVA和CMT均显著改善，且VMA+组患者BCVA较VMA-组患者增益更明显\〖-0.20(-0.33，-0.10)LogMAR vs-0.20(-0.30，-0.10)LogMAR，P=0.041\〗，但两组患者CMT变化值无差异(P=0.914)。随访期间，VMA+组患者中3眼基线时为局灶性VMA的患眼均发生黄斑部PVD(100.0%)，基线时为广泛性VMA的患者31眼中5眼发生了黄斑部PVD(16.1%)，局灶性粘连较广泛性粘连的患者更易发生黄斑部PVD(P=0.009)。

结论：BRVO患者合并VMA时抗VEGF治疗后视力改善的潜力更大，故VMA的存在不妨碍抗VEGF治疗BRVO的疗效。

METHODS: Retrospective case study. According to initially diagnosed OCT characteristics, 110 patients(110 eyes), selected from those who received intravitreal injection of Conbercept in the ophthalmology department of our hospital from January 2017 to May 2019,were divided into VMA-present group(VMA+ group, 34 eyes)and VMA-free group(VMA- group, 76 eyes). After the first injection, at least 6mo follow-up was ensured, to record the number of injection and to examine the best corrected visual acuity(BCVA)and central macular thickness(CMT). And it's via the OCT reports to evaluate status of the vitreous macular adhesion and the occurrence of posterior vitreous detachment(PVD).

RESULTS: During the 6mo follow-up after the first injection, there was no difference in the average number of intravitreal injections between patients in VMA+ group and VMA- group(2.91±1.05 times vs 3.08±1.22 times, P=0.915). At the 6mo after the first injection, BCVA and CMT were significantly improved in both groups, and BCVA gain in VMA+ group was more obvious than that in VMA- group \〖-0.20(-0.33, -0.10)LogMAR vs -0.20(-0.30, -0.10), P=0.041\〗, but there was no difference in CMT changes between the two groups(P=0.914). During this follow-up period, in the VMA+ group, 3 eyes, which were focal VMA at baseline, all developed into macular PVD(100.0%); and 5 of 31 eyes, which were extensive VMA at baseline, developed into macular PVD(16.1%). Compared with the extensive VMA, PVD was more likely to develop into focal VMA(P=0.009).

CONCLUSION: BRVO patients combined with VMA have greater potentiality in visual improvements under anti-VEGF treatments. Therefore, the presence of VMA does not prevent BRVO patients from receiving anti-VEGF therapy.