Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, #4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
Graefes Arch Clin Exp Ophthalmol. 2012 Jan;250(1):61-70. doi: 10.1007/s00417-011-1774-x. Epub 2011 Aug 27.
PURPOSE: To investigate the correlation between foveal photoreceptor integrity and final visual acuity (VA) after treatment of eyes with diabetic macular edema (DME), and to determine the visual prognostic factors. METHODS: We retrospectively studied 61 eyes of 52 patients with DME who were treated successfully with intravitreal triamcinolone injection (IVTA). Using spectral domain optical coherence tomography (SD-OCT), the eyes were categorized into three groups at the final visit according to restoration of the photoreceptor inner and outer segment junction (IS/OS) and the external limiting membrane (ELM): (1) the A group, with a completely visible IS/OS and ELM, (2) the B group, with a disrupted IS/OS and intact ELM, and (3) the C group, with a disrupted or loss of the IS/OS and ELM. Disrupted IS/OS length (DIL), disrupted ELM length (DEL), and mean disrupted IS/OS and ELM length (DIEL) were measured at the initial and final visits. Foveal thickness (FT), macular center thickness (MCT), and outer nuclear layer (ONL) thickness were also measured at the initial and final visits. Multivariate analysis testing was performed over the measured SD OCT variables. RESULTS: Final VA was closely associated with IS/OS integrity at the final visit; final VA (logMAR) in the A group (0.21 ± 0.14; 31 eyes) or B group (0.31 ± 0.21; 15 eyes) was significantly better than that in the C group (0.45 ± 0.33; 15 eyes) (p < 0.001). Shorter DIL, DEL, and DIEL at the final visit were associated with better final VA. Multivariate analysis showed that DIEL (r = 0.564) have the greatest correlation coefficient with final VA compared to DIL (r = 0.561) and DEL (r = 0.540). Better VA, preservation of the IS/OS and ELM at the initial visit were associated with intact photoreceptor integrity after resolution of DME. However, MCT, FT, and ONL thickness had no significant correlation with photoreceptor integrity. CONCLUSION: IS/OS and ELM are useful hallmarks for use in evaluation of foveal photoreceptor layer integrity, and are closely associated with final VA in DME. Pretreatment VA and photoreceptor status can predict potential restoration of photoreceptor integrity and subsequent visual recovery in DME.
目的：研究糖尿病性黄斑水肿（DME）患者经治疗后中心凹光感受器完整性与最终视力（VA）的相关性，并确定视觉预后因素。
方法：我们回顾性研究了 52 例 61 只接受曲安奈德玻璃体腔注射（IVTA）成功治疗的 DME 患者的眼睛。在最终随访时，使用频域光学相干断层扫描（SD-OCT）根据光感受器内节/外节连接（IS/OS）和外界膜（ELM）的恢复情况将眼睛分为三组：（1）A 组，IS/OS 和 ELM 完全可见；（2）B 组，IS/OS 中断但 ELM 完整；（3）C 组，IS/OS 和 ELM 中断或缺失。在初始和最终随访时测量光感受器 IS/OS 长度（DIL）、ELM 长度（DEL）和平均光感受器 IS/OS 和 ELM 长度（DIEL）。还在初始和最终随访时测量中心凹厚度（FT）、黄斑中心厚度（MCT）和外核层（ONL）厚度。对测量的 SD-OCT 变量进行多元分析检验。
结果：最终 VA 与最终随访时 IS/OS 完整性密切相关；A 组（0.21±0.14；31 只眼）或 B 组（0.31±0.21；15 只眼）的最终 VA（logMAR）明显优于 C 组（0.45±0.33；15 只眼）（p<0.001）。最终随访时较短的 DIL、DEL 和 DIEL 与更好的最终 VA 相关。多元分析显示，与 DIL（r=0.561）和 DEL（r=0.540）相比，DIEL（r=0.564）与最终 VA 的相关系数最大。更好的 VA、初始时 IS/OS 和 ELM 的保留与 DME 消退后光感受器完整性的恢复有关。然而，MCT、FT 和 ONL 厚度与光感受器完整性无显著相关性。
结论：IS/OS 和 ELM 是评估中心凹光感受器层完整性的有用标志，与 DME 中的最终 VA 密切相关。治疗前 VA 和光感受器状态可预测 DME 中光感受器完整性的潜在恢复和随后的视力恢复。
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