雷珠单抗治疗糖尿病性黄斑水肿1年后视力及中心子野厚度变化的相关因素。
Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab.
作者信息
Bressler Susan B, Qin Haijing, Beck Roy W, Chalam Kakarla V, Kim Judy E, Melia Michele, Wells John A
机构信息
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
Arch Ophthalmol. 2012 Sep;130(9):1153-61. doi: 10.1001/archophthalmol.2012.1107.
OBJECTIVE
To identify factors that predict the success or failure of treatment with intravitreal ranibizumab for patients with diabetic macular edema.
METHODS
A total of 37 baseline demographic, systemic, ocular, optical coherence tomographic, and fundus photographic variables were assessed for association with change in visual acuity or central subfield thickness between baseline and 1 year in 361 eyes that were randomly assigned to intravitreal ranibizumab with prompt or deferred laser treatment within a trial of ranibizumab, triamcinolone acetonide, and laser treatment for center-involved diabetic macular edema. A categorical variable describing follow-up anatomic responses to therapy was added to the visual acuity outcome model.
RESULTS
After adjusting for baseline visual acuity, a larger visual acuity treatment benefit was associated with younger age (P< .001), less severe diabetic retinopathy on clinical examination (P= .003), and absence of surface wrinkling retinopathy (P< .001). The reduction in central subfield thickness during the first treatment year also predicted better visual acuity outcomes (P< .001). After adjusting for baseline central subfield thickness, the presence of hard exudates was associated with more favorable improvement on optical coherence tomographic scan (P= .004). Because only 11 eyes experienced vision loss and 6 eyes experienced an increase in central subfield thickness, factors for poor outcomes could not be evaluated.
CONCLUSIONS
A review of baseline factors and anatomic responses during the first year of ranibizumab therapy for association with visual acuity outcome did not identify any features that would preclude ranibizumab treatment. However, baseline central subfield thickness is the strongest predictor of anatomic outcome, and reduction in central subfield thickness during the first treatment year is associated with better visual acuity outcomes.
目的
确定预测玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿患者成败的因素。
方法
在一项关于雷珠单抗、曲安奈德和激光治疗累及黄斑中心的糖尿病性黄斑水肿的试验中，对361只随机分配接受玻璃体内注射雷珠单抗并立即或延迟进行激光治疗的眼睛，评估了37项基线人口统计学、全身、眼部、光学相干断层扫描和眼底照相变量，以确定其与基线至1年时视力或中心子野厚度变化的相关性。在视力结果模型中增加了一个描述治疗后解剖学反应的分类变量。
结果
在调整基线视力后，更大的视力治疗获益与年龄较小（P<0.001）、临床检查时糖尿病视网膜病变较轻（P=0.003）以及无表面皱纹性视网膜病变（P<0.001）相关。首次治疗年内中心子野厚度的降低也预示着更好的视力结果（P<0.001）。在调整基线中心子野厚度后，硬性渗出物的存在与光学相干断层扫描上更有利的改善相关（P=0.004）。由于只有11只眼睛出现视力丧失，6只眼睛的中心子野厚度增加，因此无法评估不良结果的因素。
结论
回顾雷珠单抗治疗第一年的基线因素和解剖学反应与视力结果的相关性，未发现任何会排除雷珠单抗治疗的特征。然而，基线中心子野厚度是解剖学结果的最强预测因素，首次治疗年内中心子野厚度的降低与更好的视力结果相关。
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