Nixon Donald R, Flinn Nicholas
Trimed Eye Centre, Barrie, Ontario, L4M 4S5, Canada.
Department of Surgery, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.
Clin Ophthalmol. 2021 Apr 20;15:1659-1666. doi: 10.2147/OPTH.S304229. eCollection 2021.
What is the level of visual function in patients with diabetic macular edema (DME) and retinal vein occlusion (RVO) post-stabilization with anti-vascular endothelial growth factor?
This observational non-controlled single center study evaluated visual function in two patient populations with macular edema 25 with diabetic macular edema and 25 with retinal vein occlusion treated following standard protocol of anti-VEGF therapy post- stabilization.
A total of 68 eyes from 50 patients were analyzed including 18 bilateral and 7 unilateral diabetic macular edema, 14 patients with central and 11 with branch retinal vein occlusion. The mean age was 69± 11 years and 64% were male. In the RVO group: LogMAR BCVA was 0.12±0.13 compared to the unaffected eye 0.04±0.05 (P=<0.01), contrast sensitivity in the treated eye was 1.69±0.21 log units compared to 1.84± 0.15 log units in the unaffected eye (p=<0.01), the ganglion cell volume was 0.88± 0.15 mm in the treated eye compared to 1.04± 0.1 mm in the unaffected eye (P=<0.01). In the diabetic macular edema group: LogMAR BCVA was 0.17±0.13, contrast sensitivity in the treated eye was 1.16±0.21 log units compared to the normal population 1.92±0.8 log units (p=<0.01), the ganglion cell volume was 0.94± 0.14 mm in the treated eye compared to 1.03± 0.12 mm in the normal population (P=<0.001). In both groups a majority of treated eyes retained visual acuity ≥+0.4 LogMAR (diabetic macular edema 95%, RVO 96%) however contrast sensitivity was more than two standard deviations below the normal population mean in a majority of treated eyes in both groups (diabetic macular edema 88% RVO 64%).
Impairment in contrast sensitivity in both groups could impact activities of daily living including driving and should prompt questions about how we advise patients regarding their level of function and the potential limitations/restrictions that should be placed on such activities.
抗血管内皮生长因子治疗稳定后的糖尿病性黄斑水肿（DME）和视网膜静脉阻塞（RVO）患者的视觉功能水平如何？
这项观察性非对照单中心研究评估了两组黄斑水肿患者的视觉功能，其中25例为糖尿病性黄斑水肿患者，25例为视网膜静脉阻塞患者，均按照抗VEGF治疗稳定后的标准方案进行治疗。
共分析了50例患者的68只眼，包括18例双侧和7例单侧糖尿病性黄斑水肿，14例中心性视网膜静脉阻塞和11例分支性视网膜静脉阻塞。平均年龄为69±11岁，64%为男性。在RVO组中：治疗眼的LogMAR最佳矫正视力（BCVA）为0.12±0.13，而未受影响眼为0.04±0.05（P<0.01）；治疗眼的对比敏感度为1.69±0.21对数单位，未受影响眼为1.84±0.15对数单位（P<0.01）；治疗眼的神经节细胞体积为0.88±0.15mm，未受影响眼为1.04±0.1mm（P<0.01）。在糖尿病性黄斑水肿组中：治疗眼的LogMAR BCVA为0.17±0.13，治疗眼的对比敏感度为1.16±0.21对数单位，与正常人群的1.92±0.8对数单位相比（P<0.01）；治疗眼的神经节细胞体积为0.94±0.14mm，与正常人群的1.03±0.12mm相比（P<0.001）。两组中大多数治疗眼的视力保持在≥+0.4 LogMAR（糖尿病性黄斑水肿组为95%，RVO组为96%），然而两组中大多数治疗眼的对比敏感度比正常人群平均值低两个以上标准差（糖尿病性黄斑水肿组为88%，RVO组为64%）。
两组患者的对比敏感度受损可能会影响包括驾驶在内的日常生活活动，这应促使我们思考如何就患者的功能水平以及对此类活动应施加的潜在限制向患者提供建议。
