Fursova A Zh, Chubar' N V, Tarasov M S, Saifullina I F, Pustovaya G G
Novosibirsk State Regional Hospital, 130 Nemirovicha-Danchenko St., Novosibirsk, Russian Federation, 630008.
Vestn Oftalmol. 2017;133(1):11-18. doi: 10.17116/oftalma2017133111-18.
to investigate morphological changes and visual acuity response to ranibizumab therapy in patients with different OCT-types of diabetic macular edema (DME) as well as different state of the inner and outer photoreceptor segments (IS and OS) and the outer limiting membrane (OLM); to study relationships between functional and morphological parameters before and after the treatment; to study the effect of glycated hemoglobin levels on morphological parameters and ME duration.
The study included 113 patients (113 eyes) with DME, who underwent 3 once-monthly intravitreal injections of ranibizumab (the mean patient age, 63.5±2.2 years; men, 51.3%; type 2 diabetes, 81.4%). Basing on the results of OCT, 3 groups were formed: group 1 (40 patients) - intact IS and OS; group 2 (32 patients) - disturbed photoreceptor segments integrity, but intact OLM; group 3 (41 patients) - destruction of both layers.
Visual acuity at baseline and after the treatment was the highest in group 1 (p<0.05). In all groups, most parameters that indicated the state of photoreceptor segments and the OLM improved. Correlation analysis revealed a statistically significant negative correlation between visual acuity at baseline and after the treatment and morphological parameters (p<0.05). There was also a direct correlation between the morphometric parameters at baseline and after the treatment (p<0.05). The most favorable type of DME in terms of preserving the integrity of photoreceptor segments and the OLM was sponge-like edema, while DME with neuroepithelial detachment and mixed-type DME were prognostically unfavorable. Moreover, the state of photoreceptors and the OLM depended on the duration of ME and the level of glycated hemoglobin. Thus, the integrity of the inner and outer photoreceptor segments as well as the outer limiting membrane can contribute to prognosis for functional outcomes in DME patients that receive antiangiogenic therapy.
研究不同OCT类型的糖尿病性黄斑水肿（DME）患者以及内、外光感受器节段（IS和OS）和外限制膜（OLM）不同状态下，雷珠单抗治疗后的形态学变化和视力反应；研究治疗前后功能和形态学参数之间的关系；研究糖化血红蛋白水平对形态学参数和黄斑水肿持续时间的影响。
本研究纳入113例DME患者（113只眼），接受每月1次，共3次的玻璃体内注射雷珠单抗治疗（患者平均年龄63.5±2.2岁；男性占51.3%；2型糖尿病患者占81.4%）。根据OCT结果，分为3组：第1组（40例患者）——IS和OS完整；第2组（32例患者）——光感受器节段完整性受损，但OLM完整；第3组（41例患者）——两层均破坏。
第1组基线和治疗后的视力最高（p<0.05）。在所有组中，大多数表明光感受器节段和OLM状态的参数均有所改善。相关性分析显示，基线和治疗后的视力与形态学参数之间存在统计学显著负相关（p<0.05）。基线和治疗后的形态学参数之间也存在正相关（p<0.05）。就保留光感受器节段和OLM的完整性而言，最有利的DME类型是海绵状水肿，而伴有神经上皮脱离的DME和混合型DME预后不佳。此外，光感受器和OLM的状态取决于黄斑水肿的持续时间和糖化血红蛋白水平。因此，内、外光感受器节段以及外限制膜的完整性有助于接受抗血管生成治疗的DME患者功能预后的评估。
