Choovuthayakorn Janejit, Tantraworasin Apichat, Phinyo Phichayut, Patumanond Jayanton, Kunavisarut Paradee, Srisomboon Titipol, Winaikosol Pawara, Patikulsila Direk, Chaikitmongkol Voraporn, Watanachai Nawat, Pathanapitoon Kessara
Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Retina Vitreous. 2021 Mar 4;7(1):17. doi: 10.1186/s40942-021-00286-9.
BACKGROUND: To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in eyes with visual impairment from center-involved diabetic macular edema (CI-DME). METHODS: Medical records of patients with visual impairment from CI-DME, who initiated intravitreal bevacizumab injections between Jan 2012 and Dec 2016 and were followed for a minimum of 12 months were retrospectively reviewed. RESULTS: The study included 226 eyes with a mean (SD) baseline visual acuity (VA) of 51.8 (19.1) letters. At week 12, following the three initial treatments, a mean (SD) VA improved to 61.7 (17.8) letters. Visual gain ≥ 10 letters was observed in 109 eyes (48.2%), while a limited early visual gain < 5 letters was noted in 80 eyes (35.4%). At one year, 110 eyes (48.7%) achieved a good VA gain ≥ 10 letters. In addition, eyes with poor baseline VA had a higher proportion of eyes that obtained limited early VA gained at week 12 (< 5 letters) and maintained in this visual response category at moth 12 compared to eyes with better baseline VA (74.1% versus 59.1%). In the multivariable logistic regression, the following factors reduced the probability of 1-year visual gain ≥ 10 letters: elderly (p = 0.040), better baseline vision (p = 0.001), and limited early visual gain < 5 letters at week 12 (p < 0.001). In multivariable linear regression, male (p = 0.010) and eyes with the presence of hyperreflective foci on baseline OCT (p = 0.010) were likely to have higher VA improvement. However, eyes with better baseline VA (p = 0.002), limited early VA gain at week 12 (p < 0.001), and a presence of EZ disruption at week 12 (p = 0.002) were likely to have less VA improvement. CONCLUSIONS: Although bevacizumab is considered as effective management for CI-DME, variability in treatment responses is expected. This study revealed that baseline characteristics and visual responses at week 12 might help predict the long-term treatment response. Eyes with characteristics at risk of limited long-term visual outcome may require attention in optimizing their individual treatment strategies.
背景：探讨中心性糖尿病黄斑水肿（CI-DME）导致视力损害的眼中，玻璃体腔注射贝伐单抗后，光学相干断层扫描的临床特征与视网膜微观结构特征在预测1年视觉反应中的相关性。 方法：回顾性分析2012年1月至2016年12月间开始接受玻璃体腔注射贝伐单抗且随访至少12个月的CI-DME导致视力损害患者的病历。 结果：该研究纳入了226只眼，平均（标准差）基线视力（VA）为51.8（19.1）个字母。在第12周，经过最初三次治疗后，平均（标准差）视力提高到61.7（17.8）个字母。109只眼（48.2%）视力增益≥10个字母，而80只眼（35.4%）早期视力增益有限<5个字母。在1年时，110只眼（48.7%）实现了≥10个字母的良好视力增益。此外，与基线视力较好的眼相比，基线视力较差的眼中，在第12周获得有限早期视力增益（<5个字母）并在第12个月维持在该视力反应类别的眼的比例更高（74.1%对59.1%）。在多变量逻辑回归中，以下因素降低了1年视力增益≥10个字母的概率：年龄较大（p = 0.040）、基线视力较好（p = 0.001）以及第12周早期视力增益有限<5个字母（p < 0.001）。在多变量线性回归中，男性（p = 0.010）和基线光学相干断层扫描（OCT）上有高反射灶的眼（p = 0.010）视力改善可能更高。然而，基线视力较好的眼（p = 0.002）、第12周早期视力增益有限（p < 0.001）以及第12周存在椭圆体带中断的眼（p = 0.002）视力改善可能较少。 结论：尽管贝伐单抗被认为是CI-DME的有效治疗方法，但治疗反应存在差异。本研究表明，基线特征和第12周的视觉反应可能有助于预测长期治疗反应。具有长期视力预后有限风险特征的眼在优化其个体化治疗策略时可能需要关注。
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