Long-Term Visual Outcomes and Morphologic Biomarkers of Vision Loss in Eyes With Diabetic Macular Edema Treated With Anti-VEGF Therapy
Long-Term Visual Outcomes and Morphologic Biomarkers of Vision Loss in Eyes With Diabetic Macular Edema Treated With Anti-VEGF Therapy
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DOI：
10.1016/j.ajo.2021.09.002
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发表时间：
2021-12-03
影响因子：
4.2
通讯作者：
Querques, Giuseppe
中科院分区：
文献类型：
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作者：
Borrelli, Enrico;Grosso, Domenico;Querques, Giuseppe
目的：分析抗血管内皮生长因子（anti-VEGF）治疗糖尿病视网膜病变（DR）和糖尿病黄斑水肿（DME）的形态学特征和长期视力结局。设计：回顾性临床队列研究。方法：纳入在开始抗vegf治疗后5年随访后至少1次（研究访问）有DME缓解证据的长期随访患者。在研究访问中，我们回顾了结构光学相干断层扫描（OCT）的定性特征，以反映神经视网膜或视网膜色素上皮（RPE）的损害。还提供了内部和外部视网膜厚度的定量地形评估。结果：共纳入61只眼（50例），根据研究访视时的视力（VA）分为2个亚组，其中VA < 20/40组24只眼（“差/中视力”组），VA >= 20/40组37只眼（“好视力”组）。差/中级视力组外限制膜（ELM）和RPE带断裂或缺失的频率更高（P = 0.003和P = 0.019）。同样，视网膜内层紊乱在差/中级视力组中更为普遍（P = 0.013）。视力差/中等视力的眼中央凹和旁中央凹外视网膜厚度减小（P = 0.022和P = 0.044）。多元逐步线性回归分析显示，VA与RPE和ELM的外观（P < 0.0001和P = 0.048）、中央凹和中央凹旁视网膜外厚度（P = 0.046和P = 0.035）相关。结论：外视网膜和RPE的改变代表了抗vegf治疗DME患者眼睛长期视力结果的OCT生物标志物。(C) 2021爱思唯尔公司版权所有。)
PURPOSE: To analyze the morphological characteristics , long-term visual outcomes in eyes with diabetic retinopathy (DR) and diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) therapy.DESIGN: Retrospective clinical cohort study.METHODS: Patients with a long-term follow-up and evidence of resolved DME in at least 1 visit (study visit) after 5 years of follow-up after the initiation of anti-VEGF therapy were included. At the study visit, structural optical coherence tomography (OCT) scans were reviewed for qualitative features reflecting a distress of the neuroretina or retinal pigment epithelium (RPE). A quantitative topographical assessment of the inner and outer retinal thicknesses was also provided.RESULTS: A total of 61 eyes (50 patients) were included and were divided into 2 subgroups according to visual acuity (VA) at the study visit, yielding a group of 24 eyes with a VA < 20/40 ("poor/intermediate vision" group) , 37 eyes with a VA >= 20/40 ("good vision" group). The external limiting membrane (ELM) and RPE bands were more frequently disrupted or absent in the poor/intermediate vision group (P = .003 and P = .019). Similarly, disorganization of retinal inner layers was more prevalent in the poor/intermediate vision group (P = .013). The foveal and parafoveal outer retinal thicknesses were reduced in eyes with poor/intermediate vision (P = .022 and P = .044). Multivariate stepwise linear regression analysis demonstrated that VA was associated with appearances of the RPE and ELM (P < .0001 and P = .048), foveal and parafoveal outer retinal thicknesses (P = .046 and P = .035).CONCLUSIONS: Modifications in the outer retina and RPE represent OCT biomarkers of long-term visual outcomes in eyes with DME treated with anti-VEGF. ((C) 2021 Elsevier Inc. All rights reserved.)