Weingessel Birgit, Miháltz Kata, Gleiss Andreas, Sulzbacher Florian, Schütze Christopher, Vécsei-Marlovits Pia V
Department of Ophthalmology, Hietzing Hospital, Wolkersbergenstrasse 1, Vienna, Austria.
Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery, Wolkersbergenstrasse 1, Vienna, Austria.
J Ophthalmol. 2018 Oct 1;2018:3082560. doi: 10.1155/2018/3082560. eCollection 2018.
Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics.
Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up.
Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD = 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD = 0.04, logMAR: 0.4), =0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD = 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD = 0.04, 0.4 logMAR), =0.4), these were statistically insignificant. There was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD = 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD = 0.22, 0.2 logMAR), < 0.01).
Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.
对接受玻璃体内抗血管内皮生长因子（抗VEGF）联合局部激光治疗的糖尿病性黄斑水肿（DME）患者进行长期随访，并确定预后形态学特征。
对50只初治DME眼进行前瞻性临床试验，按1∶1随机分组，分别接受玻璃体内注射雷珠单抗（0.5mg/0.05ml）并立即进行格栅样激光治疗，以及雷珠单抗治疗并延迟激光治疗。在随访的基线、第6个月、第9个月以及第1、2、3、4和5年评估可能与预后相关的形态学特征。
尽管在第12周时立即治疗组的功能结果略高（0.5；20/40斯内伦视力表（标准差=0.04，0.3对数最小分辨角）对0.4；20/50斯内伦视力表（标准差=0.04，对数最小分辨角：0.4），P=0.4）以及第9个月时（立即治疗组：0.5；20/40斯内伦视力表（标准差=0.03，0.3对数最小分辨角）对延迟治疗组：0.4；20/50斯内伦视力表（标准差=0.04，0.4对数最小分辨角），P=0.4），但这些差异无统计学意义。与延迟治疗组相比，立即治疗组在长期随访期间的功能方面没有显著益处。在第5年时，中心黄斑区有高反射灶簇的眼中的最佳矫正视力（BCVA）低于没有这些改变的眼（0.39；20/50斯内伦视力表，（标准差=0.25，0.4对数最小分辨角）对0.63；20/80斯内伦视力表（标准差=0.22，0.2对数最小分辨角），P<0.01）。
格栅样激光联合雷珠单抗治疗在DME的长期随访管理中有效。频域光学相干断层扫描（SD-OCT）中的视网膜内高反射物质与BCVA呈负相关。
