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OCT生物标志物作为地塞米松种植体治疗糖尿病性黄斑水肿的功能预测因子

Zur, D., Iglicki, M., Busch, C., Invernizzi, A., Mariussi, M., Loewenstein, A.

期刊名称:Ophthalmology

卷期:2018年第125卷第2期

摘要

摘要:目的:对糖尿病黄斑水肿(DME)患者的识别和鉴定,对个性化治疗和优化结果具有重要意义。我们通过玻璃体腔内注射地塞米松(DEX)植入物,研究光学相干断层扫描(OCT)生物标志物对糖尿病黄斑水肿治疗。

设计:多通道,回顾性,观察性对照试验。

参与者:共284名患者的299只眼睛使用玻璃体腔内注射地塞米松(DEX)种植体治疗糖尿病黄斑水肿(na ve, n = 209;难治性(抗药/难降解),n = 90)。在一个对数最小角度的分辨率视力表上基线最佳矫正视力(BCVA)是在0.31.0之间。

方法:在玻璃体腔内注射地塞米松(DEX)植入前利用光学相干断层扫描(OCT)对皮下组织液、囊样改变的大小和位置、内段外段(IS-OS)的连续性、高反射病灶的数量和位置、玻璃体界面异常和视网膜前膜进行了评估。在基线和玻璃体腔内注射地塞米松(DEX)植入后的124个月后记录最佳矫正视力和中央黄斑的厚度。利用广义估计方程法分析光学相干断层扫描(OCT)测量与视觉矫正结果的相关性。

主要结果测量:通过玻璃体腔内注射地塞米松(DEX)植入治疗后在基线OCT测量的光谱域(SD) 与其对应的最佳矫正视力结果的相关性(从基线的平均变化;分类的改进(< 55 - 9或≥10;早期治疗糖尿病视网膜病变]在最佳矫正视力)。

结果:视网膜下积液(优势比[OR]1.98; 95%置信区间[CI]1.23-3.20;P = 0.01) 同源限制因子(HRF)缺失(优势比,3.66;95%置信区间,1.40-9.62;P = 0.01)和内段外段(IS-OS)层的完整性(优势比,2.09;95%置信区间,1.30-3.37;P = 0.003)在使用DEX植入物治疗后,均能预测较好的视觉效果。虽然糖尿病黄斑水肿的眼睛比难治性眼睛获得了更多的视力(P < 0.001),但光学相干断层扫描(OCT)的预测价值并没有根据这一分类而有所不同。

结论:频域OCT技术在鉴别糖尿病黄斑水肿中(DME)的各种影像学发现时很有用。在糖尿病黄斑水肿中(DME)的眼睛中,那些有皮下液体,没有同源限制因子(HRF),和连续内段外段(IS-OS)层的人对玻璃体腔内注射地塞米松(DEX)植入物的反应比没有这些特征的人更好。这些发现要求进一步对光学相干断层扫描(OCT)和代谢生物标志物的组合进行研究。

PURPOSE:Identification and characterization of patients with diabetic macular edema (DME) are important for individualizing treatment and optimizing outcome. We investigated OCT biomarkers for DME treated by intravitreal dexamethasone (DEX) implant.DESIGN:Multicenter, retrospective, observational cohort study.PARTICIPANTS:A total of 299 eyes from 284 patients treated with DEX implant for DME (na ve, n = 209; refractory, n = 90). Baseline best-corrected visual acuity (BCVA) was between 0.3 and 1.0 on a logarithm of minimum angle of resolution visual chart.METHODS:The OCT scans previous to DEX implants were evaluated for submacular fluid, size and location of cystoid changes, inner segment-outer segment (IS-OS) continuity, quantity and location of hyperreflective foci (HRF), vitreomacular interface abnormalities, and epiretinal membrane. The BCVA and central macular thickness were recorded at baseline and at 1, 2, and 4 months after treatment with DEX implants. Correlations between OCT measures and visual outcome were analyzed using the generalized estimating equations procedure.MAIN OUTCOME MEASURES:The correlation between spectral-domain (SD) OCT measures at baseline and BCVA response (mean change from baseline; categorized improvement [<5, 5-9, or 10; Early Treatment Diabetic Retinopathy Study letters] in BCVA) after treatment with a DEX implant.RESULTS:The presence of subretinal fluid (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.23-3.20; P = 0.01), absence of HRF (OR, 3.66; 95% CI, 1.40-9.62; P = 0.01), and integrity of the IS-OS layer (OR, 2.09; 95% CI, 1.30-3.37; P = 0.003) were all predictive of better visual outcome after treatment with DEX implants. Although eyes with na ve DME gained more vision than refractory eyes (P < 0.001), the predictive value of OCT findings did not differ according to this classification.CONCLUSIONS:Spectral-domain OCT is useful in identifying various imaging findings in DME. Among eyes with DME, those with submacular fluid, no HRF, and a continuous IS-OS layer responded better to DEX implants than those without these features. These findings call for further study of combinations of OCT and metabolic biomarkers.


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