Veloso Carlos E, Brocchi Daniel N, Singh Rishi P, Nehemy Márcio B
Department of Ophthalmology, Federal University of Minas Gerais, Avenida Nossa Senhora do Carmo 90, Savassi, Belo Horizonte, MG, 30330-000, Brazil.
Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
Int J Retina Vitreous. 2021 Mar 19;7(1):23. doi: 10.1186/s40942-021-00295-8.
The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome.
This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release.
The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7 % were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473 μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9 %), ranibizumab (37.9 %) and bevacizumab (21.2 %). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3 %) developed VMA release following a mean of 5.7 injections (range: 3-13). Sixteen eyes (72.7 %) with focal VMA and 6 eyes (27.3 %) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm).
VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.
本研究旨在评估抗血管内皮生长因子（VEGF）治疗糖尿病性黄斑水肿（DME）后玻璃体黄斑粘连（VMA）松解的发生率，并评估治疗效果的进一步变化。
这是一项回顾性研究，纳入了66例DME患者的66只眼，这些患者在基线时经光谱域光学相干断层扫描（OCT）诊断为VMA。VMA分为局限性（粘连：≤1500μm）或广泛性（粘连：>1500μm）。所有患者均接受至少3次每月一次的玻璃体内抗VEGF药物注射。每次注射后1个月进行随访，以评估VMA松解的发生率。
患者平均年龄为61.4岁（范围：29至78岁），男性占72.7%。基线时平均最佳矫正视力为0.62 logMAR，平均中心视网膜厚度（CRT）为473μm。平均随访时间为18.5个月，平均注射次数为5.8次。使用的玻璃体内药物为阿柏西普（40.9%）、雷珠单抗（37.9%）和贝伐单抗（21.2%）。47只眼为广泛性VMA，19只眼为局限性VMA。22只眼（33.3%）在平均5.7次注射（范围：3 - 13次）后发生VMA松解。基线时16只局限性VMA眼（72.7%）和6只广泛性VMA眼（27.3%）发生了VMA松解。21只发生VMA松解的眼在VMA松解后CRT有所改善（平均：-106μm；范围：22至289μm）。
抗VEGF治疗后，约1/3的DME患者会发生VMA松解。其中大多数患者的CRT短期内会下降。
