Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria.
Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Vienna, Austria.
Acta Ophthalmol. 2019 Dec;97(8):e1054-e1061. doi: 10.1111/aos.14173. Epub 2019 Jun 22.
To examine the prevalence of central retinal atrophy in patients treated for diabetic macular edema (DME) in a clinical setting.
Retrospective data analysis of patients with DME, focusing on those who developed central retinal thinning after DME treatment at the Department of Ophthalmology, Medical University Vienna. Patient characteristics and clinical data including best-corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescence angiography images were reviewed and DME treatment strategies analysed using descriptive statistics. The correlation between visual acuity and ocular, systemic or DME treatment factors was calculated using linear regression models and ancovas.
A total of 6684 outpatient visits by 1437 patients with diabetes were analysed. Out of 149 patients, who had had a central subfield thickness (CST) below 200 μm, 32 (36 eyes) had previously been diagnosed with a centre involving DME with an average CST of 473 ± 103 μm and average visual acuity of 0.62 ± 0.44 logMAR at first presentation. At the time of central atrophy, 29 (81%) out of 36 eyes had a history of laser treatment, 11 (31%) a vitrectomy, 32 (88%) repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF; mean 5.3 ± 3.8) and 22 (61%) intravitreal corticosteroid injections (mean 2.5 ± 2.7). Visual function (0.67 ± 0.43 logMAR) at the time of atrophy was not significantly correlated to central retinal thickness (191 ± 7 μm) or any other ocular, systemic or treatment factors.
Only 4% of patients treated for DME developed central retinal thinning in our observation period. On average, our atrophy patients had higher CST and lower BCVA when they first presented with DME compared to the overall DME cohort, and they received a combination of intravitreal injections and laser for DME treatment. Central retinal atrophy might not be attributed to excessive use of intravitreally applied anti-VEGF or any other DME therapy alone.
在临床环境中检查接受糖尿病性黄斑水肿（DME）治疗的患者中中心性视网膜萎缩的患病率。
对维也纳医科大学眼科接受 DME 治疗的患者进行回顾性数据分析，重点关注 DME 治疗后出现中心性视网膜变薄的患者。回顾患者特征和临床数据，包括最佳矫正视力（BCVA）、频域光学相干断层扫描和荧光血管造影图像，并使用描述性统计分析 DME 治疗策略。使用线性回归模型和协方差分析计算视力与眼部、全身或 DME 治疗因素之间的相关性。
共分析了 1437 名糖尿病患者的 6684 次门诊就诊。在 149 名中央视网膜厚度（CST）低于 200μm 的患者中，有 32 名（36 只眼）既往被诊断为累及中心的 DME，平均 CST 为 473±103μm，初次就诊时平均视力为 0.62±0.44logMAR。在发生中心性萎缩时，36 只眼中有 29 只（81%）有激光治疗史，11 只（31%）有玻璃体切除术史，32 只（88%）重复玻璃体内注射抗血管内皮生长因子（VEGF；平均 5.3±3.8 次），22 只（61%）玻璃体内皮质类固醇注射（平均 2.5±2.7 次）。萎缩时的视力功能（0.67±0.43logMAR）与中央视网膜厚度（191±7μm）或任何其他眼部、全身或治疗因素均无显著相关性。
在我们的观察期内，只有 4%接受 DME 治疗的患者出现中心性视网膜变薄。平均而言，与整体 DME 队列相比，我们的萎缩患者在首次出现 DME 时 CST 更高，BCVA 更低，并且接受了玻璃体内注射和激光联合治疗 DME。中心性视网膜萎缩可能不能归因于玻璃体内应用抗 VEGF 或任何其他 DME 治疗的过度使用。
