Universitätsklinik für Augenheilkunde, Bern, Switzerland.
Invest Ophthalmol Vis Sci. 2011 May 18;52(6):3334-7. doi: 10.1167/iovs.10-6097.
The purpose of this study was to analyze predictive factors for best-corrected visual acuity (BCVA) after anti-VEGF treatment in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO).
This prospective study enrolled treatment-naive patients with ME secondary to CRVO. BCVA, ophthalmoscopy, fundus photography, and spectral domain optical coherence tomography (SD-OCT) imaging were performed. SD-OCT was analyzed for integrity of the external limiting membrane (ELM), photoreceptor inner segments (IS), and outer segments (OS). Patients were treated with intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg). BCVA outcome was analyzed 4 weeks after the first injection.
Sixty-two eyes of 62 patients (39 men, 23 women; mean age: 67 ±16 years) were included. In 55%, the ELM was intact. These eyes also showed intact photoreceptor IS/OS in horizontal and vertical single scans. Disturbed ELM was seen in 45% and was accompanied by focal disintegration of IS/OS. Four weeks after injection, 58% showed clinically relevant increases of BCVA (≥5 letters). Mean BCVA ranged from 20 to 86 letters. The mean BCVA increase was 18 ± 12 letters in eyes with intact ELM compared with 4 ± 10 letters with disturbed ELM (P < 0.001).
Depending on the integrity of the outer retinal layers, the authors observed rapid and clinically relevant improvement in BCVA after the first anti-VEGF injection. In the development of an optimal treatment regime, the indication for treatment and re-treatment should be based on functional and morphologic findings, such as the deterioration of outer retinal layers. Intact ELM in SD-OCT imaging is associated with better visual outcomes after intravitreal anti-VEGF treatment in patients with ME secondary to CRVO.
本研究旨在分析继发于视网膜中央静脉阻塞（CRVO）的黄斑水肿（ME）患者接受抗血管内皮生长因子（VEGF）治疗后最佳矫正视力（BCVA）的预测因素。
本前瞻性研究纳入了继发于 CRVO 的 ME 且未经治疗的患者。进行了 BCVA、眼底镜检查、眼底照相和频域光相干断层扫描（SD-OCT）成像。对 SD-OCT 进行了外节层（ELM）、光感受器内节（IS）和外节（OS）的完整性分析。患者接受了玻璃体内注射贝伐单抗（1.25mg）或雷珠单抗（0.5mg）治疗。在第一次注射后 4 周分析 BCVA 结果。
纳入 62 只眼（62 例患者，39 名男性，23 名女性；平均年龄：67±16 岁）。在 55%的眼中，ELM 完整。这些眼的水平和垂直单扫描中也显示光感受器 IS/OS 完整。在 45%的眼中观察到 ELM 受损，并伴有 IS/OS 的局灶性解体。注射后 4 周，58%的眼显示 BCVA（≥5 个字母）有临床相关的提高。平均 BCVA 范围从 20 到 86 个字母。与 ELM 受损的眼相比（4±10 个字母），ELM 完整的眼的平均 BCVA 增加了 18±12 个字母（P<0.001）。
根据外视网膜层的完整性，作者观察到首次抗 VEGF 注射后 BCVA 迅速且具有临床相关性的改善。在制定最佳治疗方案时，治疗和再治疗的适应证应基于功能和形态学发现，例如外视网膜层的恶化。SD-OCT 成像中 ELM 的完整性与继发于 CRVO 的 ME 患者玻璃体内抗 VEGF 治疗后更好的视力结局相关。
