玻璃体腔抗血管内皮生长因子治疗糖尿病黄斑水肿后外节带和椭圆体带的序贯修复。
Sequential restoration of external limiting membrane and ellipsoid zone after intravitreal anti-VEGF therapy in diabetic macular oedema.
机构信息
Department of Ophthalmology, King George's Medical University, Lucknow, India.
Department of Biochemistry, King George's Medical University, Lucknow, India.
出版信息
Eye (Lond). 2021 May;35(5):1490-1495. doi: 10.1038/s41433-020-1100-0. Epub 2020 Jul 20.
BACKGROUND/OBJECTIVES: To study the mechanism of restoration of retinal photoreceptor ellipsoid zone (EZ), after intravitreal bevacizumab (IVB) therapy, in diabetic macular oedema (DMO).
SUBJECTS/METHODS: Forty-four consecutive patients aged 40-65 years having type 2 diabetes mellitus (DM) with DMO were prospectively recruited for IVB therapy. It comprised of three doses (1.25 mg in 0.05 ml) of IVB at monthly intervals. Patients with other ocular and systemic diseases affecting retinal vessels and earlier ophthalmological interventions were excluded. Visual acuity (logMAR VA) was recorded. Spectral domain optical coherence tomography (SD-OCT) was performed pre and post intervention. Central sub-foveal thickness (CST) and grades of disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) and EZ were assessed. Data were statistically analysed on SPSS software. Clinical trials registry: CTRI/2019/03/018135.
RESULTS
Mean logMAR VA decreased after IVB therapy from 1.78 ± 0.07 pre-intervention to 0.42 ± 0.05 post intervention (p < 0.001). Similarly, CST reduced from 354.23 ± 15.0 µm pre-intervention to 233.18 ± 7.88 µm post intervention (p < 0.001). Among qualitative variables, DRIL decreased from 93.2% pre-intervention to 13.6% post intervention. Likewise, global ELM disruption reduced from 81.8 to 9.1% and global EZ disruption reduced from 79.5 to 11.4%. ELM restoration preceded EZ restoration.
CONCLUSION
Anti-VEGF therapy restores the barrier effect of ELM. It causes ELM to restore first followed by EZ restoration in DMO.
背景/目的：研究玻璃体内注射贝伐单抗（IVB）治疗糖尿病性黄斑水肿（DMO）后视网膜光感受器椭圆体带（EZ）恢复的机制。
对象/方法：前瞻性招募了 44 名年龄在 40-65 岁之间的 2 型糖尿病（DM）合并 DMO 的连续患者，接受 IVB 治疗。它包括每月间隔的三次剂量（0.05ml 中的 1.25mg）。排除了其他影响视网膜血管的眼部和全身疾病以及早期眼科干预的患者。记录视力（logMAR VA）。进行频域光学相干断层扫描（SD-OCT）在干预前后进行。评估中央黄斑中心凹下厚度（CST）和视网膜内层（DRIL）、外部限制膜（ELM）和 EZ 排列紊乱的程度。数据在 SPSS 软件上进行统计分析。临床试验注册号：CTRI/2019/03/018135。
结果
IVB 治疗后平均 logMAR VA 从干预前的 1.78±0.07 降至干预后的 0.42±0.05（p<0.001）。同样，CST 从干预前的 354.23±15.0μm 降至干预后的 233.18±7.88μm（p<0.001）。在定性变量中，DRIL 从干预前的 93.2%降至干预后的 13.6%。同样，全局 ELM 中断从 81.8%降至 9.1%，全局 EZ 中断从 79.5%降至 11.4%。ELM 的恢复先于 EZ 的恢复。
结论
抗 VEGF 治疗恢复了 ELM 的屏障作用。它导致 ELM 首先恢复，然后是 DMO 中的 EZ 恢复。
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