自动化 RetmarkerDR 图像分析评估糖尿病视网膜病变中的微动脉瘤转换——作为 ranibizumab 治疗反应的潜在生物标志物。

Microaneurysm turnover in diabetic retinopathy assessed by automated RetmarkerDR image analysis--potential role as biomarker of response to ranibizumab treatment.

机构信息

Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany.

出版信息

Ophthalmologica. 2014;231(4):198-203. doi: 10.1159/000357505. Epub 2014 Mar 19.

DOI:10.1159/000357505

PMID:24662930

Abstract

PURPOSE

To evaluate the influence of a ranibizumab treatment on microaneurysm (MA) turnover in diabetic retinopathy.

METHODS

Sixty-nine eyes were included in this retrospective study. We compared a group of 33 eyes with ranibizumab treatment for diabetic macular edema to 36 eyes with nonproliferative diabetic retinopathy only. Nonmydriatic ultra-widefield scanning laser ophthalmoscopy (Optomap) images were obtained at a mean 4.76 ± 1.69 days prior to the first ranibizumab injection (baseline) and again 35.94 ± 2.44 days after the third consecutive injection in a 4-week interval. In untreated controls, images were obtained at baseline and 97.81 ± 3.16 days thereafter. Images were analyzed using the RetmarkerDR software (Critical Health SA, Coimbra, Portugal), and the turnover of MAs was documented and analyzed. Thereafter, MA turnover was correlated with central retinal thickness (CRT) as assessed by OCT.

RESULTS

At baseline, patients in the treatment group had 5.64 ± 0.75 MAs. One month after 3 ranibizumab injections, measured MAs decreased to 4.03 ± 0.66. In the untreated control group, the initial number of 3.36 ± 0.6 MAs remained almost unchanged over 3-4 months (2.89 ± 0.57 MAs). Dynamic analysis showed that after ranibizumab treatment 3.06 ± 0.5 new MAs appeared, while 5.09 ± 0.79 disappeared. In the control group, 2.11 ± 0.4 new MAs appeared and 2.61 ± 0.48 disappeared. MA turnover was significantly higher with ranibizumab compared to the control group (8.15 ± 1.14 vs. 4.72 ± 0.81, p < 0.001). Consistently, CRT decreased from 444 to 330 µm in the ranibizumab group, while there was no change in the control group (291 vs. 288 µm).

CONCLUSION

The treatment of macular edema using ranibizumab does not only reduce macular thickness, but also has an impact on the turnover of MAs in diabetic retinopathy. RetmarkerDR analysis showed that more pre-existent MAs disappeared than new MAs developed, and the absolute number of MAs also decreased.

摘要

目的

评估雷珠单抗治疗对糖尿病视网膜病变中微动脉瘤（MA）周转的影响。

方法

本回顾性研究纳入 69 只眼。我们比较了一组 33 只眼接受雷珠单抗治疗糖尿病性黄斑水肿与 36 只眼仅患有非增生性糖尿病性视网膜病变的情况。在第一次雷珠单抗注射前平均 4.76 ± 1.69 天（基线）和 4 周间隔内第三次连续注射后 35.94 ± 2.44 天，使用非散瞳超广角扫描激光检眼镜（Optomap）获取图像。在未治疗的对照组中，在基线和之后的 97.81 ± 3.16 天获取图像。使用 RetmarkerDR 软件（Critical Health SA，葡萄牙科英布拉）分析图像，并记录和分析 MA 的周转情况。此后，将 MA 周转与 OCT 评估的中央视网膜厚度（CRT）相关联。

结果

在基线时，治疗组患者有 5.64 ± 0.75 个 MA。在接受 3 次雷珠单抗注射后 1 个月，测量的 MA 减少至 4.03 ± 0.66。在未治疗的对照组中，最初的 3.36 ± 0.6 个 MA 在 3-4 个月内几乎没有变化（2.89 ± 0.57 个 MA）。动态分析显示，雷珠单抗治疗后出现 3.06 ± 0.5 个新的 MA，而消失 5.09 ± 0.79 个 MA。在对照组中，出现 2.11 ± 0.4 个新的 MA，消失 2.61 ± 0.48 个 MA。与对照组相比，雷珠单抗治疗后的 MA 周转明显更高（8.15 ± 1.14 比 4.72 ± 0.81，p < 0.001）。一致地，雷珠单抗组 CRT 从 444µm 降至 330µm，而对照组无变化（291µm 比 288µm）。