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






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。


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。


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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