Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
IRCCS - Fondazione Bietti, Rome, Italy.
Acta Diabetol. 2020 Feb;57(2):163-171. doi: 10.1007/s00592-019-01389-4. Epub 2019 Aug 2.
To analyze the visual outcome after early switch to dexamethasone (DEX) in eyes with diabetic macular edema previously treated with ranibizumab (RNB), based on structural spectral-domain optical coherence tomography (SD-OCT) features.
Retrospective study of data from 28 eyes which underwent a loading dose of three monthly RNB injections and were then shifted to DEX implant injection. SD-OCT analysis was performed before switch to DEX (week 12, 12W) according to the presence of integrity of ellipsoid zone (EZ) and external limiting membrane (ELM), disorganization of retinal inner layers (DRIL), and quantity of hyper-reflective spots (HRS). Best-corrected visual acuity (BCVA) changes at different time points after DEX (month 1, 1M; 4 months, 4M; and 12 months, 12M) were compared among groups.
Significantly better BCVA was achieved at 1M in eyes with intact EZ (84.2 ± 12.3 letters; p = 0.04), with intact ELM (83.2 ± 11.5 letters; p < 0.01), and with fewer HRS (84.6 ± 12.5 letters; p = 0.03). However, the greatest percentage visual increase was achieved in eyes with disrupted EZ (+ 11.4%; p < 0.01), with disrupted ELM (+ 17.2%; p < 0.01), without DRIL (+ 12.5%; p < 0.01), and with more HRS (+ 14.3%; p = 0.04). After 12 months, a significant BCVA gain was observed only in eyes with intact retinal inner layers (+ 14.2%; p = 0.03).
Greater percentage BCVA improvement at 1M after switch to DEX was associated with EZ disruption, ELM disruption, intact retinal inner layers, and higher quantity of HRS. A switch to DEX therapy would be useful in patients with these SD-OCT features.
根据结构谱域光相干断层扫描（SD-OCT）特征，分析先前接受雷珠单抗（RNB）治疗的糖尿病黄斑水肿患者转为地塞米松（DEX）后的视力结果。
回顾性研究 28 只眼的数据，这些眼接受了三次每月雷珠单抗注射的负荷剂量，然后转为 DEX 植入物注射。在转为 DEX 前（第 12 周，12W）根据椭圆体带（EZ）和外界膜（ELM）的完整性、视网膜内层紊乱（DRIL）和高反射斑点（HRS）的数量进行 SD-OCT 分析。比较 DEX 后不同时间点（第 1 个月，1M；第 4 个月，4M；第 12 个月，12M）的最佳矫正视力（BCVA）变化，并在各组之间进行比较。
EZ 完整的眼（84.2±12.3 个字母；p=0.04）、ELM 完整的眼（83.2±11.5 个字母；p<0.01）和 HRS 较少的眼（84.6±12.5 个字母；p=0.03）在 1M 时获得了明显更好的 BCVA。然而，EZ 中断的眼（+11.4%；p<0.01）、ELM 中断的眼（+17.2%；p<0.01）、无 DRIL 的眼（+12.5%；p<0.01）和 HRS 较多的眼（+14.3%；p=0.04）获得了最大的视力百分比增加。12 个月后，仅在视网膜内层完整的眼（+14.2%；p=0.03）观察到 BCVA 显著改善。
转为 DEX 后 1M 时 BCVA 改善百分比更大与 EZ 中断、ELM 中断、视网膜内层完整和更多的 HRS 相关。在具有这些 SD-OCT 特征的患者中，转为 DEX 治疗可能是有用的。
