Department of Ophthalmology and Vision Science, University of California Davis, Sacramento, California.
California Northstate University College of Medicine, Grove, California.
Retina. 2021 Oct 1;41(10):2132-2139. doi: 10.1097/IAE.0000000000003167.
To identify clinical and anatomic factor-associated vision loss in eyes with treatment-naïve diabetic macular edema and good initial visual acuity.
Retrospective cohort study after long-term history of eyes with untreated center-involving diabetic macular edema and baseline visual acuity ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 and March 2018. We collected characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, visual acuity, and diabetic retinopathy severity; and spectral-domain optical coherence tomography biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of retinal inner layers, and outer layer disruptions to determine factors associated with vision loss as defined by DRCR Protocol V as threshold for initiating aflibercept therapy.
Fifty-six eyes (48 patients) with untreated diabetic macular edema and mean baseline visual acuity of logMAR 0.05 ± 0.05 (Snellen 20/22) were followed for an average of 5.1 ± 3.3 years, with a median time to vision loss of 465 days (15 months). Older age (hazard ratio [HR] 1.04/year, P = 0.0195) and eyes with severe NPDR (HR 3.0, P = 0.0353) or proliferative diabetic retinopathy (HR 7.7, P = 0.0008) had a higher risk of a vision loss event. None of the spectral-domain optical coherence tomography biomarkers were associated with vision loss except central subfield thickness (HR 0.98, P = 0.0470) and cyst diameter (HR 1.0, P = 0.0094).
In eyes with diabetic macular edema and good initial vision, those with older age and worse diabetic retinopathy severity should be monitored closely for prompt treatment initiation when vision loss occurs.
确定未经治疗的糖尿病黄斑水肿（DME）且初始视力良好的眼睛中与临床和解剖因素相关的视力丧失。
对 2007 年 3 月至 2018 年 3 月期间在加利福尼亚大学戴维斯分校眼科中心就诊的未经治疗的中心性 DME 且基线视力≥20/25 的未经治疗的眼睛进行了长期病史的回顾性队列研究。我们收集了包括糖尿病类型、糖化血红蛋白、视觉症状、视力和糖尿病视网膜病变严重程度等特征；以及频域光相干断层扫描生物标志物，包括中央视网膜厚度、视网膜内囊肿大小、视网膜内高反射灶、视网膜内层紊乱和外层中断，以确定与视力丧失相关的因素，DRCR 方案 V 将其定义为开始阿柏西普治疗的阈值。
56 只（48 例）未经治疗的 DME 且平均基线视力为 logMAR 0.05 ± 0.05（Snellen 20/22）的眼睛平均随访 5.1 ± 3.3 年，中位视力丧失时间为 465 天（15 个月）。年龄较大（风险比 [HR] 1.04/年，P = 0.0195）和患有严重非增殖性糖尿病视网膜病变（NPDR）（HR 3.0，P = 0.0353）或增殖性糖尿病视网膜病变（HR 7.7，P = 0.0008）的眼睛发生视力丧失事件的风险更高。除中央视网膜厚度（HR 0.98，P = 0.0470）和囊肿直径（HR 1.0，P = 0.0094）外，频域光相干断层扫描生物标志物均与视力丧失无关。
在 DME 和初始视力良好的眼睛中，年龄较大和糖尿病视网膜病变严重程度较高的患者应密切监测，以便在视力丧失发生时及时开始治疗。
