Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion
Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion
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DOI：
10.1001/jamaophthalmol.2018.4484
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发表时间：
2019-01-01
影响因子：
8.1
通讯作者：
Singh, Rishi P.
中科院分区：
文献类型：
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作者：
Babiuch, Amy S.;Han, Michael;Singh, Rishi P.
重要性视网膜内层结构紊乱（DRIL）已被证实与中心受累的糖尿病黄斑水肿的视力（VA）有显著相关性。在患有视网膜静脉阻塞（RVO）和继发性黄斑水肿的患者中，DRIL可能是确定VA outcome.Objective的有用的生物标志物，以检查基线和治疗后DRIL是否与RVO中的VA相关。设计、设置和参与者对147名18岁或18岁以上的初治分支RVO（BRVO）、中央RVO（CRVO）或半球RVO（HRVO）患者的记录进行回顾性分析，对2010年12月1日至2016年1月1日在三级眼科中心就诊的患者进行了至少12个月的随访。数据收集持续到2017年1月。排除标准包括活动性混杂视网膜或眼部疾病、睫状体平坦部玻璃体切除术史或既往玻璃体内注射。两名盲法分级者根据基线、6个月和12个月时频域光学相干断层扫描上3个预定义区域的DRIL存在情况计算DRIL评分。第三个盲法分级者用于差异。暴露抗血管内皮生长因子（AVF）治疗主要结果和指标：用于确定VA结果的基线DRIL评分以及VA与响应AVF治疗的DRIL负荷变化的相关性。（平均[SD]年龄，68.9 [13.1]岁; 75 [51.0%]女性），在91只眼（61.9%）中观察到基线DRIL。在BRVO组而非CRVO组中，基线DRIL与基线早期治疗糖尿病视网膜病变研究（ETDRS）评分较低相关（无DRIL组评分为66.7，DRIL组评分为54.6，P = 0.002）。CRVO/HRVO组基线时无DRIL与6个月时VA增加相关，根据基线VA进行调整（无DRIL的评分变化为19.50，DRIL为12.72; P = 0.04）。在12个月期间，BRVO中持续存在DRIL与6个月内VA增加较少相关（DRIL增加组的评分变化为6.2，DRIL减少组为18.6，DRIL稳定组为2.9; P = 0.02）。CRVO/ HRVO的DRIL评分增加与6个月时VA改善减少相关（DRIL增加组的评分变化为-0.12，DRIL减少组为16.90，DRIL稳定组为8.45; P = 0.002）和12个月（DRIL增加组的评分变化为-1.91，DRIL减少组为17.83，DRIL稳定组为6.97;结论和相关性AVF治疗继发于RVO的黄斑水肿的基础DRIL存在和DRIL负荷变化可能是ETDRS评分改善的有用生物标志物。
IMPORTANCE Disorganization of retinal inner layers (DRIL) has demonstrated significant correlations with visual acuity (VA) in center-involved diabetic macular edema. In patients with retinal vein occlusion (RVO) and secondary macular edema, DRIL may be a useful biomarker in determining VA outcomes.OBJECTIVE To examine whether DRIL at baseline and after treatment is associated with VA in RVO.DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records of 147 patients 18 years or older with treatment-naive branch RVO (BRVO), central RVO (CRVO), or hemispheric RVO (HRVO), with a minimum of 12 months of follow-up, who presented to a tertiary ophthalmic center from December 1, 2010, to January 1, 2016, was conducted. Data collection continued through January 2017. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy, or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in 3 predefined regions on spectral-domain optical coherence tomography at baseline, 6 months, and 12 months. A third masked grader was used for discrepancies.EXPOSURES Anti-vascular endothelial growth factor (AVF) therapy (ranibizumab, aflibercept, or bevacizumab) determined by the treating physician.MAIN OUTCOMES AND MEASURES The DRIL score at baseline for determining VA outcomes and correlation of VA with changes in DRIL burden in response to AVF therapy.RESULTS In the 147 patients (mean [SD] age, 68.9 [13.1] years; 75 [51.0%] female), baseline DRIL was seen in 91 eyes (61.9%). In the BRVO group but not the CRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study (ETDRS) score (score of 66.7 for no DRIL vs 54.6 for DRIL, P = .002). Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at 6 months, adjusting for baseline VA (score change of 19.50 for no DRIL vs 12.72 for DRIL; P = .04). During 12 months, continued DRIL presence in BRVO was associated with less VA gain up to 6 months (score change of 6.2 for the DRIL increase group vs 18.6 for the DRIL decrease group vs 2.9 for the DRIL stable group; P = .02). Increasing DRIL scores in CRVO/ HRVO were associated with reduced VA improvement at 6 months (score change of -0.12 for the DRIL increase group vs 16.90 for the DRIL decrease group vs 8.45 for the DRIL stable group; P = .002) and 12 months (score change of - 1.91 for the DRIL increase group vs 17.83 for the DRIL decrease group vs 6.97 for the DRIL stable group; P < .001).CONCLUSIONS AND RELEVANCE Baseline DRIL presence and DRIL burden changes with AVF therapy for macular edema secondary to RVO may be useful biomarkers of ETDRS score improvements.