Peripheral retinal dysfunction in diabetic macular edema.
Peripheral retinal dysfunction in diabetic macular edema.
复制标题
糖尿病黄斑水肿的周围视网膜功能障碍。
DOI：
10.1111/aos.15221
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发表时间：
2023
影响因子：
3.4
通讯作者：
Gardner,ThomasW
中科院分区：
文献类型：
--
作者：
Omari,Amro;Su,Lydia;Joltikov,KatherineA;Rao,RajeshC;Jayasundera,KanishkaThiran;Gardner,ThomasW
亲爱的编辑，患有糖尿病黄斑水肿（DME）的患者主要用玻璃体内抗VEGF或类固醇注射治疗（威尔斯等人，2015），但30%-40%的患者对抗VEGF治疗没有完全反应（Stewart，2014）。DME的当前临床评价是基于视网膜血管病变的程度和黄斑状态，如通过光学相干断层扫描（OCT）判断的，但DR影响整个视网膜神经血管单元，包括神经元、血管、神经胶质、无长突细胞和Müller细胞（Antonetti等人，2012年）。DME患者对治疗的不完全反应可能是由于除VEGF外的血管生成因子的影响，或产生这些因子的神经血管视网膜的状态。因此，本研究的基本原理是，全面评估整个神经血管单位，包括黄斑和周边视网膜中的DR和DME，可能会提供更好的了解疾病，并导致更有效的治疗在未来。我们采用功能和结构测试，以检查DME和周边视野功能的关系，在23名受试者DME（18名男性，5名女性;平均年龄52.7岁; SD= 9.8）。入选标准包括由视网膜专家确定诊断为临床显著DME的患者（基于临床检查和伴有视网膜增厚的黄斑囊肿的SD-OCT）。排除标准包括任何可能影响视力的眼部或全身性疾病（DR除外）、任何既往眼内手术、既往糖尿病视网膜病变治疗或无法提供书面知情同意书。中枢功能检查包括视敏度和倍频视野检查。使用Octopus Perimetry测试周边视网膜功能，其在颞视野中从视觉中心测试多达100个（评估鼻视网膜），在鼻视野中测试多达70个（评估颞视网膜），在上级视野中测试多达50个（评估下视网膜），并且在下视野中测试多达70个（评估上级视网膜）。所有受试者进行OCT测量中心黄斑厚度和黄斑体积和彩色眼底照相，以分级DR的严重程度。中心和周边视力之间的关系进行了评估，使用皮尔逊相关性检验。统计学显著性设定为p< 0.05。4例患者有轻度NPDR，11例有中度NPDR，5例有重度NPDR，3例有非高危PDR。DME患者的平均HbA 1c为10.2 mmol/L，CMT范围为209-560 mm，黄斑体积为2.97-17.01 mm 3;平均ETDRS视力为80.7个字母。患者的平均Octopus静态外周视野检查
Dear Editor, Patients with diabetic macular edema (DME) are treated primarily with intravitreal anti-VEGF or steroid injections (Wells et al., 2015), yet 30%–40% of patients fail to fully respond to anti-VEGF treatments (Stewart, 2014). Current clinical evaluation of DME is based on the extent of retinal vascular lesions and macular status as judged by optical coherence tomography (OCT), but DR affects the entire retinal neurovascular unit, including neurons, blood vessels, glial, amacrine, and Müller cells (Antonetti et al., 2012). Incomplete responses to treatment in DME may be due to the influence of angiogenic factors in addition to VEGF, or on the state of the neurovascular retina producing those factors. Hence, the rationale for this study is that comprehensive assessment of the entire neurovascular unit, including the macula and midperipheral retina in DR and DME, may provide better understanding of the disease and leads to more effective treatment in the future.We employed functional and structural tests to examine the relationship between DME and peripheral visual field function in 23 subjects with DME (18 males, five females; mean age of 52.7 years; SD= 9.8) at the Kellogg Eye Center. Inclusion criteria included patients with a diagnosis of clinically significant DME as determined by a retinal specialist (based on both clinical exam and SD-OCT with macular cysts accompanied by retinal thickening). Exclusion criteria included any ocular or systemic disease other than DR that could affect vision, any previous intraocular surgery, previous treatment for diabetic retinopathy, or inability to provide written informed consent. Tests of central function included visual acuity and frequency doubling perimetry. Peripheral retinal function was tested using Octopus Perimetry, which tests up to 100 from the center of vision in the temporal field (assessing nasal retina), 70 in the nasal field (assessing temporal retina), 50 in the superior field (assessing inferior retina), and 70 in the inferior field (assessing superior retina). All subjects had OCT with measurements of central macular thickness and macular volume and colour fundus photography to grade the severity of DR. Relationships between central and peripheral vision were evaluated using Pearson correlation tests. Statistical significance was set at p< 0.05. Four patients had mild NPDR, 11 had moderate NPDR, five had severe NPDR, and three had non-high-risk PDR. Patients with DME had an average HbA1c of 10.2 mmol/L and a range of CMT 209–560 mm and macular volume of 2.97–17.01 mm3; mean ETDRS acuity was 80.7 letters. Patients had mean Octopus static peripheral perimetry