Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Ağrı İbrahim Çeçen University, Ağrı Merkez, Turkey.
Int Ophthalmol. 2021 May;41(5):1783-1798. doi: 10.1007/s10792-021-01737-w. Epub 2021 Feb 19.
To evaluate anatomical and neuroretinal functional aspects in patients with diabetic macular edema (DME) after intravitreal anti-vascular endothelial growth factor (VEGF) therapy, in particular aflibercept.
This prospective single-centered interventional study was performed at Afyonkarahisar Health Science University Faculty of Medicine, Department of Ophthalmology, where 32 eyes of 32 patients with DME were investigated. All patients received five intravitreal aflibercept injections on a monthly basis and were followed up for ≥ 6 months. After a comprehensive ophthalmological examination, including the measurements of visual acuity and intraocular pressure, and an antero-posterior segment slit-lamp biomicroscopy before and after full pupil dilation, fundus fluorescein angiography and optical coherence tomography were performed at baseline and during the third and sixth months post-therapy. Microperimetry and multifocal electroretinography were also performed at baseline and during the sixth months.
Mean visual acuity increased from 0.73 to 0.57 and 0.33 logarithm of the minimum angle of resolution (logMAR) during the third and sixth months, respectively (p < 0.001). Changes in intraocular pressure were not statistically significant (p = 0.472). There was statistically significantly decreased mean central macular thickness from 390.2 μm to 242.6 and 289.7 μm during the third and sixth months, respectively (p < 0.001). Significantly improved fixation patterns during the sixth month, along with significantly increased macular sensitivity from 8.2 to 14.2 dB (p < 0.001) and significantly decreased local deficit from - 10.3 to 5.5 dB (p < 0.001) were observed. Further, there was a significantly increased N1 amplitude in the first ring and significantly increased P1 amplitude in all rings (p for each parameter < 0.05). There was also significantly decreased N1 wave implicit time in all rings and significantly decreased P1 wave in the second, third, fourth and fifth rings (p for each parameter < 0.05).
Patients with DME showed profound improvement in the retinal neurophysiological function, which was also accompanied by anatomical and ultrastructural integrity recovery after intravitreal aflibercept therapy. In the pathogenesis of DME, the influence of neurodegeneration has been increasingly gaining significant attention. Consequently, the need to assess neurophysiological effects of anti-VEGF therapy using a variety of diagnostic measures like electrophysiological studies and multimodal imaging technologies is undeniably growing.
评估糖尿病黄斑水肿（DME）患者接受玻璃体腔内抗血管内皮生长因子（VEGF）治疗，特别是阿柏西普治疗后的解剖和神经视网膜功能方面。
本前瞻性单中心干预研究在 Afyonkarahisar 健康科学大学医学院眼科进行，研究了 32 例 32 只 DME 患者的眼睛。所有患者每月接受 5 次玻璃体腔内阿柏西普注射治疗，并随访至少 6 个月。在充分散瞳前后，进行全面的眼科检查，包括视力和眼压测量，以及前节裂隙灯生物显微镜检查，同时在基线、治疗后第 3 个月和第 6 个月进行眼底荧光素血管造影和光学相干断层扫描。在基线和第 6 个月还进行了微视野和多焦视网膜电图检查。
平均视力分别在第 3 个月和第 6 个月从 0.73 提高到 0.57 和 0.33 对数最小角分辨率（logMAR）（p<0.001）。眼压变化无统计学意义（p=0.472）。中央黄斑厚度分别从 390.2μm下降到 242.6μm和 289.7μm（p<0.001）。第 6 个月观察到固视模式明显改善，黄斑敏感性从 8.2dB 增加到 14.2dB（p<0.001），局部缺损从-10.3dB 减少到 5.5dB（p<0.001）。此外，第一环的 N1 振幅显著增加，所有环的 P1 振幅均显著增加（各参数 p<0.05）。所有环的 N1 波潜伏期均显著缩短，第二、三、四、五环的 P1 波潜伏期均显著缩短（各参数 p<0.05）。
DME 患者的视网膜神经生理学功能明显改善，玻璃体腔内注射阿柏西普治疗后，视网膜解剖和超微结构也得到恢复。在 DME 的发病机制中，神经退行性变的影响越来越受到重视。因此，需要使用各种诊断措施，如电生理研究和多模态成像技术，来评估抗 VEGF 治疗的神经生理学效应。
