糖尿病性黄斑水肿伴神经视网膜脱离：抗 VEGF 和皮质类固醇治疗反应的 OCT 和 OCT 血管造影生物标志物。
Diabetic macular edema with neuroretinal detachment: OCT and OCT-angiography biomarkers of treatment response to anti-VEGF and steroids.
机构信息
Eye Clinic, University Hospital Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
出版信息
Acta Diabetol. 2020 Mar;57(3):287-296. doi: 10.1007/s00592-019-01424-4. Epub 2019 Sep 21.
PURPOSE
To assess and compare early changes in neuroinflammatory and vascular parameters in diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND) after treatment with intravitreal dexamethasone (DEX-I) and ranibizumab (IVR).
METHODS
Thirty-three eyes (33 patients) with treatment naïve DME with SND were retrospectively evaluated at baseline and 2 months after DEX-I (15 eyes) and 1 month after 3 monthly IVR injections (18 eyes). Inclusion criteria were: complete eye examination, good quality OCT and OCT-A images. OCT parameters included: central macular thickness (CMT); number of hyper-reflective retinal spots (HRS) in inner, outer (IR, OR) and full retina; choroidal thickness (CT), extent of disorganization of inner retinal layers (DRIL), outer retina integrity (OR). On OCT-A: foveal avascular zone (FAZ) parameters in the superficial capillary plexus (SCP); cysts area and perfusion density (PD) in SCP and deep capillary plexus (DCP) and flow voids (FV) in choriocapillaris. FAZ was analyzed using ImageJ, perfusion parameters and FV using MATLAB.
RESULTS
BCVA increased equally after both treatments (13.0 ± 10.0 ETDRS letters, p < 0.0001). There was a similar decrease (p < 0.05) in: height of SND, cysts area at SCP, central and mean CT, increase in FAZ perimeter and OR integrity, after both treatments. A greater decrease in DEX-I versus IVR group was found in: CMT (- 38.7% vs. - 22.2%, p = 0.012), HRS number in IR (- 29.2% vs. - 14.0%, p = 0.05) and full retina (- 24.7% vs. - 8.0%, p = 0.03), DRIL extension (- 62.0% vs. - 24%, p = 0.008), cysts area at DCP (- 68.7% vs. - 26.1%, p = 0.03), FAZ-CI (- 19.1% vs. - 8.3%, p = 0.02), PD at DCP (- 27.5% vs. + 4.9%, p = 0.02). FV did not change.
CONCLUSIONS
More pronounced changes in specific inflammatory parameters in the inner retina are documented after steroid versus anti-VEGF treatment. These include reduction in HRS number, DRIL extension, CMT, cysts area at DCP. These data may help in further study of noninvasive imaging biomarkers for better evaluation of treatment response.
目的
评估和比较玻璃体内注射地塞米松（DEX-I）和雷珠单抗（IVR）治疗伴中心凹下神经视网膜脱离（SND）的糖尿病性黄斑水肿（DME）患者的早期神经炎症和血管参数变化。
方法
回顾性分析 33 只（33 例）未经治疗的 DME 合并 SND 患者的基线和 DEX-I 治疗后 2 个月（15 只眼）和 3 个月 IVR 注射后 1 个月（18 只眼）的数据。纳入标准为：全面眼部检查、高质量 OCT 和 OCT-A 图像。OCT 参数包括：中心黄斑厚度（CMT）；内、外（IR、OR）和全视网膜高反射视网膜斑点（HRS）数量；脉络膜厚度（CT），内视网膜层紊乱程度（DRIL），外视网膜完整性（OR）。在 OCT-A 中：浅层毛细血管丛（SCP）中黄斑无血管区（FAZ）参数；SCP 和深层毛细血管丛（DCP）中的囊泡面积和灌注密度（PD）和脉络膜毛细血管中的血流空洞（FV）。FAZ 使用 ImageJ 进行分析，灌注参数和 FV 使用 MATLAB 进行分析。
结果
两种治疗后视力均明显提高（13.0±10.0 ETDRS 字母，p<0.0001）。两种治疗后 SND 高度、SCP 囊泡面积、中央和平均 CT、FAZ 周长和 OR 完整性均有类似的下降（p<0.05）。与 IVR 组相比，DEX-I 组的 CMT（-38.7% vs.-22.2%，p=0.012）、IR 中的 HRS 数量（-29.2% vs.-14.0%，p=0.05）和全视网膜（-24.7% vs.-8.0%，p=0.03）、DRIL 延伸（-62.0% vs.-24%，p=0.008）、DCP 中的囊泡面积（-68.7% vs.-26.1%，p=0.03）、FAZ-CI（-19.1% vs.-8.3%，p=0.02）、DCP 中的 PD（-27.5% vs.+4.9%，p=0.02）下降更明显。FV 没有变化。
结论
与抗 VEGF 治疗相比，类固醇治疗后内视网膜特定炎症参数的变化更为明显。这些包括 HRS 数量、DRIL 延伸、CMT、DCP 中囊泡面积的减少。这些数据可能有助于进一步研究非侵入性成像生物标志物，以更好地评估治疗反应。
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