Ebneter Andreas, Wolf Sebastian, Abhishek Jain, Zinkernagel Martin S
*Department of Ophthalmology, Inselspital, Bern University Hospital and University of Bern, Switzerland; and †Department of Clinical Research, University Hospital Bern, Switzerland.
Retina. 2016 Jul;36(7):1314-23. doi: 10.1097/IAE.0000000000000923.
To identify individual retinal layer thickness changes associated with visual acuity gain in diabetic macular edema treated with ranibizumab using layer segmentation on high-resolution optical coherence tomography scans.
Retrospective observational case series. Thirty-three treatment-naive eyes with diabetic macular edema were imaged by spectral domain optical coherence tomography at monthly visits while receiving intravitreal ranibizumab treatment as needed, guided by visual acuity. Thickness changes of individual layers after 1 year were quantitatively analyzed and correlated with visual acuity gain.
The mean best-corrected visual acuity improvement at 1 year was 6.2 (SEM ± 1.5) Early Treatment Diabetic Retinopathy Study letters, and central retinal thickness decreased by 66 ± 18 μm. In the central subfield, there was a significant decrease of thickness for all layers (P < 0.05) except the outer nuclear layer. Multiple linear regression analysis revealed that thickness decrease of the inner retina was associated with better visual acuity, whereas for the outer retina the opposite was true. The best estimate of final visual acuity (R = 0.817, P < 0.001) was obtained, by including baseline visual acuity and thickness change of the inner and outer plexiform layers in the model.
Whereas thickness decrease of the inner retina was positively associated with visual acuity gain, the opposite was found for the outer retina. This might be indirect evidence for recovery of the outer retina during ranibizumab treatment.
利用高分辨率光学相干断层扫描的分层分割技术，确定雷珠单抗治疗糖尿病性黄斑水肿时与视力提高相关的视网膜各层厚度变化。
回顾性观察病例系列。33只初治的糖尿病性黄斑水肿患眼在每月随访时接受频域光学相干断层扫描成像，同时根据视力情况按需接受玻璃体内注射雷珠单抗治疗。对1年后各层的厚度变化进行定量分析，并与视力提高情况进行相关性分析。
1年后平均最佳矫正视力提高了6.2（标准误±1.5）个早期糖尿病性视网膜病变研究视力表字母，中心视网膜厚度减少了66±18μm。在中心子区域，除了外核层，所有层的厚度均显著下降（P<0.05）。多元线性回归分析显示，视网膜内层厚度的下降与更好的视力相关，而视网膜外层则相反。通过将基线视力以及内、外丛状层的厚度变化纳入模型，获得了对最终视力的最佳估计（R=0.817，P<0.001）。
视网膜内层厚度的下降与视力提高呈正相关，而视网膜外层则相反。这可能是雷珠单抗治疗期间视网膜外层恢复的间接证据。
