Hwang Hye Seong, Chae Ju Byung, Kim Jin Young, Kim Dong Yoon
Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea.
Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Invest Ophthalmol Vis Sci. 2017 Nov 1;58(13):5958-5967. doi: 10.1167/iovs.17-22725.
To investigate the association between hyperreflective dots (HRDs) on spectral-domain optical coherence tomography (SD-OCT) and response to intravitreal bevacizumab (IVB) or dexamethasone injection in eyes with diabetic macular edema (DME) or macular edema due to retinal vein occlusion (RVO).
A retrospective review was conducted involving patients with DME or macular edema due to RVO. Patients with treatment-naïve macular edema were initially treated with three consecutive IVB injections and classified based on the treatment response to bevacizumab. After three consecutive IVB injections, bevacizumab nonresponders were treated using dexamethasone implants and reclassified based on the treatment response. The best-corrected visual acuity, number of HRDs, and outer plexiform layer (OPL) disruptions were analyzed according to the treatment response.
Eighty-two eyes with DME and 68 eyes with RVO were included in this study. Thirty-six (43.9%) eyes with DME and 22 (32.4%) eyes with RVO were bevacizumab nonresponders. The number of baseline HRDs in bevacizumab nonresponders (16.06 ± 6.60 in DME, 14.23 ± 4.09 in RVO) was significantly greater than that in responders (11.26 ± 3.64, P < 0.001 in DME, 11.17 ± 4.83, P = 0.013 in RVO), and it did not decrease after IVB injections. Unlike the response to bevacizumab, eyes that responded to dexamethasone implant but not to IVB had significantly more HRDs (19.56 ± 6.75) than eyes that did not respond (11.50 ± 3.78, P = 0.006). The OPL disruption rate was significantly higher in bevacizumab nonresponders than in responders (P < 0.001 in DME and P = 0.001 in RVO).
In patients with DME or macular edema due to RVO, the number of HRDs on SD-OCT may be a predictive indicator of the response to IVB injection or dexamethasone implant. In bevacizumab responders, the number of HRDs on SD-OCT was small. In contrast, more HRDs, which might reflect increased inflammation in the retina, were observed in dexamethasone responders. Therefore, dexamethasone implants might be more effective in DME or RVO eyes with multiple HRDs and OPL disruption on SD-OCT.
探讨糖尿病性黄斑水肿（DME）或视网膜静脉阻塞（RVO）所致黄斑水肿患者的光谱域光学相干断层扫描（SD - OCT）上的高反射点（HRD）与玻璃体内注射贝伐单抗（IVB）或地塞米松的反应之间的关联。
对DME或RVO所致黄斑水肿患者进行回顾性研究。初治黄斑水肿患者首先连续接受三次IVB注射，并根据对贝伐单抗的治疗反应进行分类。连续三次IVB注射后，对贝伐单抗无反应者使用地塞米松植入物治疗，并根据治疗反应重新分类。根据治疗反应分析最佳矫正视力、HRD数量和外丛状层（OPL）破坏情况。
本研究纳入82只DME眼和68只RVO眼。36只（43.9%）DME眼和22只（32.4%）RVO眼对贝伐单抗无反应。贝伐单抗无反应者的基线HRD数量（DME中为16.06±6.60，RVO中为14.23±4.09）显著多于有反应者（DME中为11.26±3.64，P<0.001；RVO中为11.17±4.83，P = 0.013），且IVB注射后未减少。与对贝伐单抗的反应不同，对地塞米松植入物有反应但对IVB无反应的眼的HRD明显多于无反应的眼（19.56±6.75比11.50±3.78，P = 0.006）。贝伐单抗无反应者的OPL破坏率显著高于有反应者（DME中P<0.001，RVO中P = 0.001）。
在DME或RVO所致黄斑水肿患者中，SD - OCT上的HRD数量可能是对IVB注射或地塞米松植入物反应的预测指标。在对贝伐单抗有反应者中，SD - OCT上的HRD数量较少。相比之下，在地塞米松有反应者中观察到更多的HRD，这可能反映视网膜炎症增加。因此，地塞米松植入物可能对SD - OCT上有多个HRD和OPL破坏的DME或RVO眼更有效。
