Department of Ophthalmology, Konkuk University School of Medicine, Seoul, Republic of Korea.
Ophthalmology. 2012 May;119(5):1056-65. doi: 10.1016/j.ophtha.2011.11.018. Epub 2012 Feb 18.
PURPOSE: To investigate the correlation between fundus autofluorescence (FAF) and the results of spectral-domain optical coherence tomography (SD-OCT) as well as visual acuity (VA) in patients with diabetic macular edema (DME) and to determine the visual prognostic factors. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Sixty-one patients with DME who underwent intravitreal injection of bevacizumab (IVB) as their first treatment. METHODS: An assessment of VA and FAF and SD-OCT images were obtained before and after IVB (pre- and post-IVB). Foveal FAF was graded on a scale of 1 to 4. The presence or absence of FAF at the foveola was also determined. MAIN OUTCOME MEASURES: The association of FAF with VA and the SD-OCT results, including central macular thickness (CMT), outer nuclear layer thickness, the integrity of the external limiting membrane (ELM), and the integrity of the junction between the inner and outer segment of the photoreceptor (IS/OS). RESULTS: Better VA, preservation of the ELM, and IS/OS pre-IVB were associated with better VA post-IVB. Of the types of DME, cystoid macular edema significantly correlated with increased FAF at the foveola. A higher level of FAF was 5.6 times more likely to occur in DME with a defect in IS/OS and 10 times more likely to occur with each 10-μm increase in CMT. Each increase by a factor of 0.1 in the logarithm of the minimum angle of resolution (logMAR) pre-IVB increased the probability of high FAF by a factor of 1.73. Despite severe DME, fewer eyes with a low level of FAF exhibited an IS/OS defect and large logMAR VA than eyes with a high level of FAF with severe DME pre-IVB. The average grade of FAF pre-IVB was higher in patients with decreased vision during follow-up than in patients with increased or unchanged good vision. CONCLUSIONS: The strong association of FAF with SD-OCT parameters and VA in patients with DME could aid in the prediction of the restoration of photoreceptor integrity and subsequent visual recovery, especially in patients with severe DME, in whom photoreceptor integrity before treatment could not be adequately evaluated, even with SD-OCT.
目的：探讨眼底自发荧光（FAF）与糖尿病黄斑水肿（DME）患者的光谱域光相干断层扫描（SD-OCT）结果和视力（VA）之间的相关性，并确定其视觉预后因素。
设计：回顾性、干预性病例系列研究。
参与者：61 例接受玻璃体内注射贝伐单抗（IVB）作为首次治疗的 DME 患者。
方法：在 IVB 前后（IVB 前和 IVB 后）评估 VA、FAF 和 SD-OCT 图像。FAF 在 1 到 4 的范围内分级。还确定了在中心凹下是否存在 FAF。
主要观察指标：FAF 与 VA 和 SD-OCT 结果（包括中央黄斑厚度[CMT]、外核层厚度、外部限制膜[ELM]的完整性和光感受器内外节交界处[IS/OS]的完整性）的相关性。
结果：更好的 VA、IVB 前 ELM 和 IS/OS 的保存与 IVB 后更好的 VA 相关。在 DME 类型中，囊样黄斑水肿与中心凹下 FAF 增加显著相关。IS/OS 缺陷的 DME 中 FAF 水平较高的可能性增加 5.6 倍，CMT 每增加 10μm，发生的可能性增加 10 倍。IVB 前 logMAR 最小角分辨率（logMAR）的每增加 0.1 倍，高 FAF 的概率增加 1.73 倍。尽管 DME 严重，但与 IVB 前严重 DME 中高 FAF 相比，低 FAF 眼的 IS/OS 缺陷和大 logMAR VA 出现的眼睛更少。与 IVB 前视力增加或不变的患者相比，在随访中视力下降的患者的 IVB 前 FAF 平均等级更高。
结论：DME 患者 FAF 与 SD-OCT 参数和 VA 的强相关性有助于预测光感受器完整性的恢复和随后的视力恢复，尤其是在 DME 严重的患者中，即使进行 SD-OCT，也不能充分评估治疗前光感受器的完整性。
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