Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Acta Ophthalmol. 2013 Nov;91(7):e529-36. doi: 10.1111/aos.12153. Epub 2013 May 7.
To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti-vascular endothelial growth factor (VEGF) treatment with Ranibizumab.
A consecutive series of 39 study eyes with centre-involving DME were included in this study. In all subjects, best-corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD-OCT) cross-sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross-sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained.
Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = -1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = -3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = -4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = -1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = -0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = -2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment.
ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti-VEGF therapy with Ranibizumab in patients with DME.
评估玻璃体内抗血管内皮生长因子（VEGF）治疗Ranibizumab 治疗糖尿病性黄斑水肿（DME）过程中的黄斑形态和功能。
本研究纳入了 39 只中心性 DME 研究眼的连续系列。在所有受试者中，均根据 ETDRS 方案、荧光素血管造影（FA）、微视野黄斑敏感性（MP）和谱域光学相干断层扫描（SD-OCT）进行最佳矫正视力（BCVA），并在治疗前和 3 个月后获得横截面 OCT 扫描。两名经验丰富的评分员对每个横截面 OCT 扫描的 6 种不同形态质量[IS/OS 层完整性、外核层（ONL）囊肿、ONL 囊肿大小、内核层（INL）囊肿、阻塞现象和视网膜下液]进行分级。获得功能和形态参数之间的相关分析。
连续 3 次每月应用 Ranibizumab 注射后，平均 BCVA 从 26 ± 14 增加到 33 ± 13 个字母（p < 0.001）。中央视网膜厚度（CRT）从 504 ± 144 降至 387 ± 122 μm（p < 0.001）。在治疗过程中，IS/OS 连续性改善（指数：0.56 ± 0.52 至 0.43 ± 0.49，Z = -1.415，p = 0.157），ONL 囊肿的发生率和大小显著降低（指数：0.61 ± 0.44 至 0.56 ± 0.35，Z = -3.41，p = 0.001 和 1.75 ± 0.88 至 1.17 ± 1.05，Z = -4.02，p < 0.001），INL 囊肿的发生率降低（指数：0.35 ± 0.52 至 0.28 ± 0.52，Z = -1.60，p = 0.109），阻塞现象无明显变化（指数：00.12 ± 0.16 至 0.13 ± 0.15，Z = -0.45，p = 0.656），视网膜下液几乎消失（指数：0.10 ± 0.24 与 0.00 ± 0.01，Z = -2.56，p = 0.011）。相关性分析显示，在治疗前和治疗过程中，ONL 囊肿的发生率及其大小与 CRT 以及 BCVA 和 MP 之间存在最高显著相关性。
在 DME 患者中，抗 VEGF 治疗 Ranibizumab 治疗过程中，ONL 囊肿及其大小等形态学参数与视网膜功能（通过 BCVA 和微视野测量）相关。
