目的：应用多模式影像观察玻璃体腔抗血管内皮生长因子(VEGF)注射在慢性中心性浆液性脉络膜视网膜病变(CCSC)合并脉络膜新生血管(CNV)的治疗效果，探讨评估其影响因素。

方法：回顾性分析30例30眼确诊为CCSC合并CNV患者的资料。所有患者均行最佳矫正视力(BCVA)、频域相干光断层扫描(SD-OCT)的增强深度成像(EDI)模式，荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)及光学相干断层扫描血管成像(OCTA)血流扫描检查。对存在黄斑区视网膜下积液(SRF)以及CNV的患眼行玻璃体腔雷珠单抗(IVR)注射治疗，采取1+PRN方案，随访时间为注药治疗后1wk，1mo，末次注药治疗后3mo。观察指标为最佳矫正视力(BCVA，LogMAR)、黄斑中心凹厚度(CMT)、黄斑中心凹下脉络膜厚度(SFCT)以及CNV血流面积。

结果：所有患眼在基线、眼内注药治疗后1wk，1mo，末次治疗后3mo时各时间点CMT有差异(F=62.06，P<0.01)； 治疗后各时间点CMT与治疗前比较均有差异(t=3.08、6.57、4.90，P=0.01、0.02、<0.01)，其中47%患者SRF最终可完全吸收(14/30)。各时间点BCVA比较有差异(F=87.21，P<0.01)； 治疗后各时间点BCVA与基线比较均有差异(t=6.52、4.71、6.01，P=0.03、<0.01、<0.01)。各时间点SFCT比较有差异(F=57.98，P<0.01)； 治疗后各时间点SFCT与基线比较均有差异(t=5.11、9.03、4.27，P=0.03、<0.01、<0.01)。各时间点CNV血流面积比较有差异(F=70.78，P<0.01)； 治疗后1wk，1mo时CNV血流面积与治疗前比较均无差异(t=7.01、6.54，P=0.07、0.05)，末次注药治疗后3mo时CNV血流面积与治疗前比较有差异(t=4.51，P=0.02)。CMT变化量与基线时的BCVA、CMT、CNV血流面积均呈显著正相关(r=0.43、0.41、0.41，P=0.02、0.03、0.03)。BCVA变化量与基线BCVA及CMT呈显著正相关(r=0.89、0.43，P<0.01、0.02)。

结论：CCSC合并CNV的患眼对抗VEGF的治疗应答敏感性不一，部分患眼的SRF通过治疗可完全吸收； CNV可能并非是引起SRF的唯一影响因子。基线时的BCVA、CMT、CNV血流面积可能是影响最终眼内注药疗效的因素。

AIM: To observe the efficacy of intravitreal anti-vascular endothelial growth factor(VEGF)injection treatment in chronic central serous chorioretinopathy(CCSC)combined with choroidal neovascularization(CNV)using multimodal imaging, to explore and evaluate the influence factors.

METHODS: In this retrospective study, 30 patients(30 eyes)were diagnosed as CCSC combined with CNV. Comprehensive ophthalmologic examinations were performed, including best corrected visual acuity(BCVA), enhanced-depth imaging(EDI)spectral domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), Indocyanine green angiography(ICGA), and optical coherence tomography angiography(OCTA). Patients were treated with intravitreal ranibizumab(IVR)parallel 1+PRN schem for subretinal fluid(SRF)secondary to CCSC combined with CNV. All the patients were followed up at 1wk, 1mo after treatment and 3mo after consecutive treatment. The BCVA, central macular thickness(CMT), subfoveal choroid thickness(SFCT)and CNV flow area were compared.

RESULTS: All the patients were observed at baseline, 1wk, 1mo after treatment and 3mo after consecutive treatment. The difference at various time points of CMT(μm)were statistically significant(F=62.06, P<0.01). CMT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(t=3.08, 6.57, 4.90; P=0.01, 0.02, <0.01). In which 46.7% of patients, SRF can be completely absorbed(14/30). The difference at various time points of BCVA(LogMAR)were statistically significant(F=87.21, P<0.01). BCVA after treatment at each time point was compared with baseline, the difference between each group was statistically significant(t=6.52, 4.71, 6.01; P=0.03, <0.01, <0.01). The difference at various time points of SFCT(μm)were statistically significant(F=57.98, P<0.01). SFCT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(t=5.11, 9.03, 4.2; P=0.03, <0.01, <0.01). The difference at various time points of CNV area(mm²)were statistically significant(F=70.78, P<0.01). CNV area at 1wk and 1mo after treatment was compared with baseline, the difference was no statistically significant(t=7.01, 6.54; P=0.07, 0.05). CNV area at 3mo after the last treatment was compared with baseline, the difference was statistically significant(t=4.51, P=0.02). The change of CMT was positively correlated with the baseline CMT, BCVA and CNV area(r=0.43, 0.41, 0.41; P=0.02, 0.03, 0.03). The change of BCVA was positively correlated with the baseline BCVA and CMT(r=0.89, 0.43; P<0.01, 0.02).

CONCLUSION: CCSC combined with CNV show different sensitivity to anti-VEGF therapy, the SRF can be completely absorbed after treatment in parts of patients. CNV may not be the only predictive factor leading to the SRF. The baseline BCVA, CMT and CNV area may be the factors that influence the final therapeutic effect of the intravitreal anti-VEGF injection therapy.