Seidensticker F, Reznicek L, Cserhati S, Liegl R G, Langer J, Wolf A, Kampik A, Ulbig M, Haritoglou C, Kernt M
Augenklinik, Ludwig-Maximilians-Universität München, Mathildenstrasse 8, Munich.
Klin Monbl Augenheilkd. 2013 May;230(5):524-9. doi: 10.1055/s-0032-1327930. Epub 2012 Dec 10.
The aim of this study was to evaluate the fixation and other functional and morphological alterations in patients with diabetic macular oedema (DMO) under intravitreal ranibizumab therapy.
Thirty patients (39 eyes) with DMO with central involvement were included in this prospective study. Morphological (fluorescein angiography, OCT) as well as functional (visual acuity, microperimetry including fixation) parameters were analysed before and after three monthly intravitreal applications of ranibizumab.
Best-corrected mean visual acuity (BCVA) increased significantly by 6.85 + 6.45 letters from 26.15 ± 13.83 to 33.03 ± 13.31 letters. Mean central retinal thickness and mean central retinal volume decreased significantly from 503.72 ± 143.78 µm, respectively (p < 0.001) before treatment to 387.05 ± 122.02 µm after the third intravitreal injection with ranibizumab. Mean retinal sensitivity obtained with microperimetry did not change significantly over the course of treatment. Mean fixation within 2° (4°) improved from 64.15 % (85.7 %) before treatment significantly to 70.15 % (91.5 %) after three intravitreal injections with ranibizumab. Mean fixation stability within 2° improved from 43.9 % before treatment significantly to 58.5 % after three intravitreal injections.
DMO improved both morphologically with a significant reduction of central retinal thickness and volume and a significantly improved BCVA as well as fixation and fixation stability over the course of three monthly intravitreal injections with ranibizumab. Retinal sensitivity obtained in microperimetry did not change significantly over the course. Based on our observations we interpret and suggest fixation and fixation stability as an early functional parameter and prior to microperimetrically detectable changes of retinal sensitivity additional to BCVA during treatment of diabetic macular edema.
本研究旨在评估玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿（DMO）患者时的固视情况以及其他功能和形态学改变。
本前瞻性研究纳入了30例（39只眼）有黄斑中心受累的DMO患者。在每月一次玻璃体内注射雷珠单抗3次之前和之后，对形态学参数（荧光素血管造影、光学相干断层扫描）以及功能参数（视力、包括固视的微视野检查）进行分析。
最佳矫正平均视力（BCVA）显著提高了6.85±6.45个字母，从26.15±13.83个字母提高到33.03±13.31个字母。平均中心视网膜厚度和平均中心视网膜体积在治疗前分别为503.72±143.78 µm（p<0.001），在第三次玻璃体内注射雷珠单抗后显著降低至387.05±122.02 µm。在治疗过程中，微视野检查获得的平均视网膜敏感度没有显著变化。2°（4°）范围内的平均固视率在治疗前为64.15%（85.7%），在三次玻璃体内注射雷珠单抗后显著提高到70.15%（91.5%）。2°范围内的平均固视稳定性从治疗前的43.9%显著提高到三次玻璃体内注射后的58.5%。
在每月一次玻璃体内注射雷珠单抗治疗3个月的过程中，DMO在形态学上得到改善，中心视网膜厚度和体积显著降低，BCVA显著提高，固视及固视稳定性也得到显著改善。在此过程中，微视野检查获得的视网膜敏感度没有显著变化。基于我们的观察结果，我们解释并建议将固视和固视稳定性作为一个早期功能参数，在糖尿病性黄斑水肿治疗期间，除BCVA外，在微视野检查可检测到视网膜敏感度变化之前。
