Vujosevic Stela, Torresin Tommaso, Bini Silvia, Convento Enrica, Pilotto Elisabetta, Parrozzani Raffaele, Midena Edoardo
Department of Ophthalmology, University of Padova, Padova, Italy.
Fondazione G. B. Bietti, IRCCS, Roma, Italy.
Acta Ophthalmol. 2017 Aug;95(5):464-471. doi: 10.1111/aos.13294. Epub 2016 Oct 24.
To evaluate changes of specific retinal imaging biomarkers [intraretinal hyper-reflective retinal spots: HRS ; subfoveal neuroretinal detachment: SND; and increased foveal autofluorescence: IFAF after intravitreal steroid or anti-vascular endothelial growth factor treatment in diabetic macular oedema (DME)] as possible indicators of retinal inflammatory condition.
Retrospective analysis of images and clinical charts of 49 eyes (49 patients) with DME treated with intravitreal dexamethasone (dexamethasone, 23 eyes) or intravitreal ranibizumab (ranibizumab, 26 eyes). All patients had fundus colour photograph, spectral domain optical coherence tomography (SD OCT) and fundus autofluorescence (FAF), best-corrected visual acuity (BCVA) and microperimetry recorded before and 1 month after the end of treatment. Central macular thickness (CMT), number of HRS and presence of SND were evaluated by SD OCT. Fundus autofluorescence images were evaluated for area of (IFAF). Retinal sensitivity within 4° and 12° from fovea was quantified by microperimetry. Changes in morphologic and functional parameters were assessed, and correlation was performed by Pearson's correlation.
Best-corrected visual acuity and CMT improved in all patients, (p < 0.05, for both groups). Mean number of HRS decreased after both treatments (p < 0.0001). Subfoveal neuroretinal detachment resolved in 85.7% dexamethasone-treated eyes (p = 0.014) and in 50% ranibizumab-treated eyes (p = 0.025). Mean IFAF area decreased in both groups, (p < 0.0001, for both). A significantly higher decrease in CMT was observed in dexamethasone- versus ranibizumab-treated eyes, (p = 0.032). In dexamethasone group, higher number of HRS at baseline and larger IFAF were correlated with higher increase in retinal sensitivity; eyes with SND at baseline had major decrease in CMT versus those without SND, (p = 0.003).
Higher number of HRS, larger area of IFAF and presence of SND may indicate a prevalent inflammatory condition in DME with specific response to targeted treatment.
评估糖尿病性黄斑水肿（DME）患者玻璃体内注射类固醇或抗血管内皮生长因子治疗后特定视网膜成像生物标志物的变化[视网膜内高反射性视网膜斑点：HRS；黄斑中心凹下神经视网膜脱离：SND；以及黄斑中心凹自发荧光增强：IFAF]，作为视网膜炎症状态的可能指标。
回顾性分析49例（49只眼）接受玻璃体内地塞米松治疗（地塞米松，23只眼）或玻璃体内雷珠单抗治疗（雷珠单抗，26只眼）的DME患者的图像和临床病历。所有患者在治疗结束前和结束后1个月均记录了眼底彩色照片、光谱域光学相干断层扫描（SD OCT）和眼底自发荧光（FAF）、最佳矫正视力（BCVA）和微视野检查结果。通过SD OCT评估黄斑中心厚度（CMT）、HRS数量和SND的存在情况。对眼底自发荧光图像评估（IFAF）面积。通过微视野检查量化距黄斑中心凹4°和12°范围内的视网膜敏感度。评估形态学和功能参数的变化，并通过Pearson相关性分析进行相关性分析。
所有患者的最佳矫正视力和CMT均有所改善（两组均p < 0.05）。两种治疗后HRS的平均数量均减少（p < 0.0001）。85.7%接受地塞米松治疗的眼黄斑中心凹下神经视网膜脱离得到缓解（p = 0.014），50%接受雷珠单抗治疗的眼得到缓解（p = 0.025）。两组的平均IFAF面积均减小（两组均p < 0.0001）。与接受雷珠单抗治疗的眼相比，接受地塞米松治疗的眼CMT的降低更为显著（p = 0.032）。在地塞米松组中，基线时HRS数量较多和IFAF面积较大与视网膜敏感度的更高增加相关；基线时有SND的眼与无SND的眼相比，CMT降低更明显（p = 0.003）。
HRS数量较多、IFAF面积较大和SND的存在可能表明DME中存在普遍的炎症状态，并对靶向治疗有特定反应。
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