Koc Feray, Güven Yusuf Ziya, Egrilmez Deniz, Aydın Erdinç
Medicine, Department of Ophthalmology, Izmir Katip Celebi University, Izmir, Turkey.
Department of Ophthalmology, Ataturk Education and Research HospitalEye Clinic, Izmir, Turkey.
Semin Ophthalmol. 2021 Aug 18;36(5-6):444-451. doi: 10.1080/08820538.2021.1907423. Epub 2021 Mar 29.
: This study aimed to identify optical coherence tomography (OCT) biomarkers for predicting response to anti-VEGF treatment in diabetic macular edema (DME) Bilateral DME patients with asymmetric response to a loading dose of anti-VEGF (ranibizumab/aflibercept) treatment were retrospectively studied. The morphologic response criterion was central subfield thickness (CST) ≤300 µm; asymmetric response was defined as ≥10% difference in CST reduction between the eyes. The functional response criterion was an increase in logMAR acuity of ≥3 lines, with an increase below this threshold in the fellow eye considered asymmetric response. Relationships between final morphologic and functional responses to anti-VEGF therapy and baseline values of the following OCT-derived biomarkers were evaluated: DME subtype, CST, vitreoretinal interface anomalies, disorganization of the inner retinal layers (DRIL), external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, and subretinal fluid (SRF). After a loading dose of anti-VEGF, 31 eyes that met both morphologic and functional response criteria were classified as responders (RR) and 27 eyes that did not respond morphologically or functionally based on the defined criteria were classified as resistant (RT). Eyes that showed only functional (n = 5) or morphological response (n = 1) were excluded due to their small number. The presence of SRF or simple epiretinal membrane (ERM) was not associated with any difference in treatment responses ( > .05), while tractional ERM, extensive DRIL (≥500 µm), and ELM and EZ disruptions in the fovea-centered 1000-µm zone were important OCT biomarkers in predicting resistance ( < .001). A multilayer perceptron model ranked predictive power as 100% for ELM disruption, 51.7% for tractional ERM, 25.4% for DRIL, and 24.5% for EZ disruption. Extensive ELM disruption was the strongest OCT biomarker to predict anti-VEGF resistance, followed by tractional ERM. EZ disruption and DRIL had relatively lower predictive value.
本研究旨在确定光学相干断层扫描（OCT）生物标志物，以预测糖尿病性黄斑水肿（DME）患者对抗血管内皮生长因子（anti-VEGF）治疗的反应。对接受抗VEGF（雷珠单抗/阿柏西普）负荷剂量治疗反应不对称的双侧DME患者进行回顾性研究。形态学反应标准为中心子野厚度（CST）≤300 µm；不对称反应定义为双眼间CST降低差异≥10%。功能反应标准为logMAR视力提高≥3行，对侧眼提高低于该阈值视为不对称反应。评估抗VEGF治疗的最终形态学和功能反应与以下OCT衍生生物标志物基线值之间的关系：DME亚型、CST、玻璃体视网膜界面异常、视网膜内层紊乱（DRIL）、外限制膜（ELM）破坏、椭圆体带（EZ）破坏和视网膜下液（SRF）。在接受抗VEGF负荷剂量治疗后，31只符合形态学和功能反应标准的眼睛被分类为反应者（RR），27只根据既定标准在形态学或功能上无反应的眼睛被分类为抵抗者（RT）。仅表现出功能反应（n = 5）或形态学反应（n = 1）的眼睛因数量较少而被排除。SRF或单纯视网膜前膜（ERM）的存在与治疗反应的任何差异均无关联（P > .05），而牵拉性ERM、广泛的DRIL（≥500 µm）以及以黄斑为中心的1000 µm区域内的ELM和EZ破坏是预测抵抗的重要OCT生物标志物（P < .001）。多层感知器模型对预测能力的排序为：ELM破坏为100%，牵拉性ERM为51.7%，DRIL为25.4%，EZ破坏为24.5%。广泛的ELM破坏是预测抗VEGF抵抗最强的OCT生物标志物，其次是牵拉性ERM。EZ破坏和DRIL的预测价值相对较低。
