Fursova A Zh, Chubar N V, Tarasov M S, Sayfullina I F, Pustovaya G G
Novosibirsk State Regional Hospital, 130 Nemirovicha-Danchenko St., Novosibirsk, Russian Federation, 630008.
Vestn Oftalmol. 2016 Jul-Aug;132(4):35-42. doi: 10.17116/oftalma2016132435-42.
to describe baseline functional and anatomical parameters of the macular region and how they change under ranibizumab therapy depending on the type of diabetic macular edema (DME) determined with optical coherence tomography (OCT).
The study included 100 patients (100 eyes) with diabetes mellitus and DME (38 men and 62 women) aged 61.9±5.6 years with the mean disease duration of 8.48 years. Basing on OCT findings, 4 groups (25 patients each) were formed: sponge-like DME, cystoid DME, DME with serous neuroepithelium detachment (NED), and mixed DME (cystoid DME and serous NED). All patients received 3 consecutive monthly injections of 0.5 mg ranibizumab. The relationship between anatomical, functional, and clinical parameters was analyzed.
The lowest visual acuity (VA) at baseline was found in patients with mixed DME (р<0.05). The greatest increase in VA after the 3 injections was noted in patients with sponge-like DME - 0.34±0.18. Retinal thickness was significantly lower (р<0.05) in sponge-like DME as compared to other groups both at baseline and after the treatment. Foveolar thickness decreased after the treatment in all groups, the effect being the most pronounced (the edema got reduced by 42.4%, р<0.05) in cystoid DME. The most significant reduction in macular volume (by 2.7 mm3) as well as its lowest absolute post-treatment values were reported for patients with cystoid edema (9.01 mm3, р<0.05 as compared to sponge-like and mixed DME). Correlation analysis revealed an evident relationship between the improvement in VA (ΔVA) and the decrease in macular volume (р<0.05). Of clinical parameters, only diabetes duration correlated with the extent of VA improvement (r=-0.3; p<0.05).
The effectiveness of intravitreal ranibizumab therapy for diffuse DME depends on the morphological type of macular edema by OCT. Moreover, it correlates with diabetes duration.
描述黄斑区的基线功能和解剖参数，以及根据光学相干断层扫描（OCT）确定的糖尿病性黄斑水肿（DME）类型，这些参数在雷珠单抗治疗下如何变化。
该研究纳入了100例糖尿病合并DME患者（100只眼）（男性38例，女性62例），年龄61.9±5.6岁，平均病程8.48年。根据OCT检查结果，分为4组（每组25例）：海绵状DME、囊样DME、伴有浆液性神经上皮脱离（NED）的DME和混合性DME（囊样DME和浆液性NED）。所有患者每月连续3次注射0.5mg雷珠单抗。分析了解剖、功能和临床参数之间的关系。
混合性DME患者基线时视力（VA）最低（p<0.05）。3次注射后，海绵状DME患者的VA提高幅度最大——0.34±0.18。与其他组相比，海绵状DME在基线和治疗后的视网膜厚度均显著更低（p<0.05）。所有组治疗后中心小凹厚度均降低，囊样DME组效果最显著（水肿减轻42.4%，p<0.05）。囊样水肿患者的黄斑体积减少最为显著（减少2.7mm³），且治疗后的绝对数值最低（9.01mm³，与海绵状和混合性DME相比，p<0.05）。相关性分析显示，VA改善（ΔVA）与黄斑体积减少之间存在明显关系（p<0.05）。在临床参数中，只有糖尿病病程与VA改善程度相关（r=-0.3；p<0.05）。
玻璃体内注射雷珠单抗治疗弥漫性DME的有效性取决于OCT检测的黄斑水肿形态类型。此外，它与糖尿病病程相关。
