光学相干断层扫描OCT生物学标记物在糖尿病性黄斑水肿治疗中的临床分析

Clinical analysis of OCT biomarkers in the treatment of diabetes macular edema

中文关键词: 老年, 糖尿病性黄斑水肿, 光学相干断层扫描, 抗VEGF治疗, 生物标记物

英文关键词: elderly  diabetic macular edema  optical coherence tomography  anti-VEGF therapy  biomarker

中文摘要:

      目的 研究在接受抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗的糖尿病性黄斑水肿(diabetic macular edema,DME)眼中的OCT生物学标记的变化特征.方法 将38例中心性DME患者的56只眼纳入研究.这些患者于2021年3月-2024年1月接受每月1次连续注射3次的玻璃体内抗VEGF注射治疗,随后进行按需治疗.治疗随访期间评估以下OCT生物标志物:中心凹神经上皮脱离(SND)[定义为存在(SND+)或不存在(SND-)]、中心凹囊腔高反射壁(HRW)[定义为:不存在(HRW-)或存在(HRW+)]、视网膜外层中断(DROL)即外界膜(ELM)完整性.在随访期间每次评估SND、HRW和ELM状态的变化.评估基线及随访期间OCT生物标志物之间的相互关联及其与视力结果的关系.结果 平均随访时间为106.3 d.基线时,30.4％的随访眼OCT中发现SND,82.1％的随访眼OCT中检测HRW.第1针以及第3针治疗后,HRW的检出率显著降低.且在第3针后随访时发现,SND的检出率较基线显著降低.SND和HRW的存在之间无明显的相关性(P=0.177).SND检出与ELM完整性之间存在显著相关性(P＜0.05,r=0.271).基线时是否存在SND、HRW及DROL其治疗前后的视力结果并无明显差异(P均＞0.05).但在基线SND(+)患眼中,如治疗后转为SND(-)其视力较治疗前明显提高(P＜0.05),但若SND持续存在则视力较治疗前未见明显好转.且在治疗期间ELM完整性未见明显改善时,治疗前后视力未见明显提高(P＞0.05).结论 基线时的SND和HRW存在与否与基线视力及治疗后视力变化间未见明显的相关性.而上述生物标志物在随访期间的动态变化可能对视力改善有显著影响.整个随访期间存在持续或复发SND以及ELM完整性未好转的患眼视觉改善欠佳.

英文摘要:

      Objective To study the changes of optical coherence tomography(OCT)biomarkers in eyes with diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(VEGF).Methods 56 eyes of 38 patients with central DME were included in this study.They received intravitreal anti-VEGF injection therapy once a month for three consec-utive times from March 2021 to January 2024,and followed by on-demand treatment.During the treatment follow-up period,the following OCT biomarkers were evaluated:subfoveal neuroretinal detachment(SND)[classified as the presence(SND+)or absence(SND-)],hyperreflective walls(HRW)of foveal cystoid spaces[classified as the absence(HRW-)or pres-ence(HRW+)],and disruption of retinal outer layers(DROL)[the integrity of external limiting membrane(ELM)].The changes in SND,HRW,and ELM were assessed at each follow-up visit during follow-up.The interrelationships between base-line of the OCT biomarkers and their changes during follow-up and their correlation with vision outcomes were evaluated.Results The average follow-up duration was 106.3 days.At baseline,SND was detected by OCT in 30.4％of eyes,and HRW was detected by OCT in 82.1％.After the first and third injections,the detection rate of HRW significantly decreased.After the third injection,it was found that the detection rate of SND decreased significantly compared to baseline values.There was no significant correlation between the presence of SND and HRW(P=0.177).There was significant correlation between SND detection and ELM integrity(P＜0.05,r=0.271).The presence or absence of SND,HRW and DROL at baseline showed no significant difference in visual acuity outcomes before and after treatment(all P＞0.05).However,in the eyes with SND(+)at baseline,if SND transformed to SND(-)after treatment,their visual acuity was significantly improved compared to that before treatment(P＜0.05).But if SND persisted,there was no significant improvement in visual acuity compared to that before treatment.When there was no significant improvement in ELM integrity during treatment,there was no significant improvement in visual acuity after treatment(P＞0.05).Conclusion There is no significant correlation between the presence or absence of SND and HRW at baseline and changes in baseline and post-treatment visual acuity.However,the dynamic changes of above biomarkers during follow-up may have a significant impact on visual improvement.The eyes with persistent or recurrent SND and poor ELM integrity during the entire follow-up period would have poor visual improvement.