Moon Byung Gil, Um Taewoong, Lee Junyeop, Yoon Young Hee
Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Asan Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ophthalmol Retina. 2018 Mar;2(3):235-243. doi: 10.1016/j.oret.2017.07.003. Epub 2017 Sep 28.
To determine the association between baseline deep capillary plexus (DCP) integrity and long-term photoreceptor recovery as well as visual outcome after treatment in patients with diabetic macular edema (DME).
Retrospective, interventional case series.
Sixty-seven eyes with DME that resolved successfully with initial treatment (baseline) and that remained edema free for 12 months after the initial DME resolution.
Best-corrected visual acuity (BCVA), spectral-domain (SD) OCT, and OCT angiography findings were collected at baseline and at 6 and 12 months after baseline. Correlations were analyzed between DCP integrity parameters (vascular flow density [VD] and area of the foveal avascular zone [FAZ]) and photoreceptor integrity parameters (ellipsoid zone [EZ] and external limiting membrane [ELM] integrity). Multivariate linear regression analysis was conducted to identify the baseline predictors for photoreceptor recovery and visual improvement.
The association between baseline DCP integrity and recovery of photoreceptor integrity over 12 months.
At baseline, the mean central retinal thickness was 306.1±51.8 μm. The mean baseline DCP VD and FAZ were 14.4±5.2% and 0.71±0.36 mm, and the mean baseline EZ and ELM integrity were 57.2±26.1% and 76.4±19.8%, respectively. Ellipsoid zone and ELM integrity recovered significantly at 12 months from baseline (both P < 0.001). The degree of EZ and ELM integrity recovery was well correlated with the baseline DCP VD (P = 0.004 and P = 0.009, respectively) and DCP FAZ (P = 0.007 and P = 0.009, respectively). Moreover, the mean change in BCVA from baseline to 12 months was significantly greater with higher baseline DCP VD (P = 0.003) and smaller DCP FAZ (P = 0.042). Compared with anti-vascular endothelial growth factor (VEGF) nonresponders, anti-VEGF responders had higher baseline DCP integrity and a significantly greater degree of photoreceptor recovery at 12 months.
The degree of DCP preservation at the time of initial DME resolution is correlated closely with long-term recovery of photoreceptor integrity and visual outcome in patients with resolved DME.
确定糖尿病性黄斑水肿（DME）患者基线深层毛细血管丛（DCP）完整性与长期光感受器恢复以及治疗后视力结果之间的关联。
回顾性、介入性病例系列研究。
67只患有DME的眼睛，初始治疗（基线）成功消退且在初始DME消退后12个月内无水肿。
在基线以及基线后6个月和12个月收集最佳矫正视力（BCVA）、光谱域（SD）光学相干断层扫描（OCT）和OCT血管造影结果。分析DCP完整性参数（血管血流密度[VD]和中心凹无血管区[FAZ]面积）与光感受器完整性参数（椭圆体带[EZ]和外界膜[ELM]完整性）之间的相关性。进行多变量线性回归分析以确定光感受器恢复和视力改善的基线预测因素。
基线DCP完整性与12个月内光感受器完整性恢复之间的关联。
基线时，平均中心视网膜厚度为306.1±51.8μm。基线时平均DCP VD和FAZ分别为14.4±5.2%和0.71±0.36mm，基线时平均EZ和ELM完整性分别为57.2±26.1%和76.4±19.8%。椭圆体带和ELM完整性在基线后12个月时较基线有显著恢复（均P<0.001）。EZ和ELM完整性的恢复程度与基线DCP VD（分别为P=0.004和P=0.009）以及DCP FAZ（分别为P=0.007和P=0.009）密切相关。此外，基线DCP VD较高（P=0.003）且DCP FAZ较小（P=0.042）时，从基线到12个月BCVA的平均变化显著更大。与抗血管内皮生长因子（VEGF）无反应者相比，抗VEGF反应者基线DCP完整性更高，且在12个月时光感受器恢复程度显著更大。
初始DME消退时DCP的保留程度与已消退DME患者光感受器完整性的长期恢复以及视力结果密切相关。
