Sim Sing Yue, Ghulakhszian Arevik, Minocha Amal, Ramcharan Dhannie, Nokhostin Soroush, Cheong-Leen Richard, George Sheena, Posner Esther, Dinah Christiana
Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.
Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK.
Clin Ophthalmol. 2021 May 20;15:2089-2097. doi: 10.2147/OPTH.S314614. eCollection 2021.
Diabetic macular oedema (DMO) is the leading cause of sight impairment in working age populations in developed countries. Current first line treatment for centre-involving DMO involves intravitreal anti-VEGF but treatment response can be variable. In this retrospective, real world, multi-centre cohort study, we aim to identify ocular and systemic characteristics that correlate with anatomical and functional outcomes for treatment-naive DMO patients treated with intravitreal aflibercept.
Retrospective multicentre cohort study of treatment-naive DMO patients initiated on aflibercept at three North West London hospitals between 2016 and 2018. Baseline systemic and ocular factors, best corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months were determined and statistically analysed.
A total of 270 eyes of 221 DMO patients met inclusion criteria. Mean age was 62.8 ± 12.1, mean baseline HbA1c was 67 ± 20 mmol/mol, and mean eGFR was 72 mL/min/1.7m. Mean number of aflibercept injections at 12 months was 6.2. Better baseline BCVA, lower baseline CMT, and absence of epiretinal membrane (ERM) were associated with better BCVA at 12 months whilst lower baseline CMT and proliferative retinopathy status were associated with lower CMT at 12 months.
Our study is the largest real-world dataset examining factors influencing functional and anatomical response to aflibercept in DMO in the UK. Older age, lower baseline BCVA, higher baseline CMT and more severe diabetic retinopathy were associated with poorer visual acuity at 12 months and prioritisation of these patients within a pressured healthcare setting is recommended.
糖尿病性黄斑水肿（DMO）是发达国家劳动年龄人群视力损害的主要原因。目前针对累及中心凹的DMO的一线治疗包括玻璃体内注射抗血管内皮生长因子（VEGF），但治疗反应可能存在差异。在这项回顾性、真实世界、多中心队列研究中，我们旨在确定与初治DMO患者接受玻璃体内注射阿柏西普治疗后的解剖和功能结局相关的眼部和全身特征。
对2016年至2018年期间在伦敦西北部三家医院开始接受阿柏西普治疗的初治DMO患者进行回顾性多中心队列研究。确定基线全身和眼部因素、12个月时的最佳矫正视力（BCVA）和中心黄斑厚度（CMT），并进行统计分析。
221例DMO患者的270只眼符合纳入标准。平均年龄为62.8±12.1岁，平均基线糖化血红蛋白（HbA1c）为67±20 mmol/mol，平均估算肾小球滤过率（eGFR）为72 mL/min/1.73m²。12个月时阿柏西普的平均注射次数为6.2次。更好的基线BCVA、更低的基线CMT以及无视网膜前膜（ERM）与12个月时更好的BCVA相关，而更低的基线CMT和增殖性视网膜病变状态与12个月时更低的CMT相关。
我们的研究是英国最大的真实世界数据集，研究了影响DMO患者对阿柏西普功能和解剖反应的因素。年龄较大、基线BCVA较低、基线CMT较高以及糖尿病视网膜病变较严重与12个月时较差的视力相关，建议在医疗资源紧张的情况下对这些患者进行优先治疗。
