Pessoa Bernardete, Marques João Heitor, Leite João, Silva Nisa, José Diana, Coelho Constança, Figueira João, Meireles Angelina, Melo-Beirão João Nuno
Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
Clin Ophthalmol. 2021 Oct 9;15:4081-4090. doi: 10.2147/OPTH.S325037. eCollection 2021.
Diabetic retinopathy staging system and progression predictors are soon to be considered insufficient for ophthalmologic practice. Given the growing evidence of the role of choroidal dysfunction, our purpose was to assess choroidal vascular changes with intravitreal ranibizumab (RBZ) treatment in diabetic macular edema (DME).
This was a prospective longitudinal cohort study. The study included DME eyes, grouped in vitrectomized (group 1) and non-vitrectomized (group 2) eyes, submitted to RBZ in a pro re nata regimen, with 24 weeks of follow-up. Main outcome measures such as central subfield foveal thickness (CFT), choroidal thickness (CT), and choroidal vascular index (CVI) were obtained from structural OCT, and choriocapillaris flow density (CCD) was obtained from OCT angiography and analyzed before and after treatment.
Thirty-one patients were included, 10 eyes in group 1 and 24 eyes in group 2. The mean number of injections was 5.18 (range 2-6). Globally, there was an improvement in BCVA (+4.3 ETDRS letters, p=0.004) and CFT (-84.6 µm, p<0.001) with no changes in CT, CVI, or CCD (p>0.05). When considering only group 2, there was a significant decrease in CT (p=0.033) and a significant increase in CCD (p=0.010) 6 months after treatment, with no differences in CVI (p=0.111). Baseline CVI was correlated with visual acuity at week 24 both globally (=0.406, p=0.029) and in group 2 (=0.604, p=0.004).
In non-vitrectomized eyes, choriocapillaris blood flow improves with RBZ. Baseline CVI may correlate with visual function after RBZ. ClinicalTrials.gov NCT04387604.
糖尿病视网膜病变分期系统和病情进展预测指标很快将被认为不足以满足眼科临床实践的需求。鉴于脉络膜功能障碍作用的证据日益增多，我们的目的是评估玻璃体内注射雷珠单抗（RBZ）治疗糖尿病性黄斑水肿（DME）时脉络膜血管的变化。
这是一项前瞻性纵向队列研究。该研究纳入了DME患眼，分为接受玻璃体切割术的患眼（第1组）和未接受玻璃体切割术的患眼（第2组），按需接受RBZ治疗，随访24周。主要观察指标如中心凹下视网膜厚度（CFT）、脉络膜厚度（CT）和脉络膜血管指数（CVI）通过结构光学相干断层扫描（OCT）获得，脉络膜毛细血管血流密度（CCD）通过OCT血管造影获得，并在治疗前后进行分析。
共纳入31例患者，第1组10只眼，第2组24只眼。平均注射次数为5.18次（范围2 - 6次）。总体而言，最佳矫正视力（BCVA）有所改善（提高4.3个ETDRS字母，p = 0.004），CFT降低（降低84.6 µm，p < 0.001），而CT、CVI或CCD无变化（p > 0.05）。仅考虑第2组时，治疗6个月后CT显著降低（p = 0.033），CCD显著增加（p = 0.010），CVI无差异（p = 0.111）。基线CVI在总体上（r = 0.406，p = 0.029）和第2组中（r = 0.604，p = 0.004）均与第24周时的视力相关。
在未接受玻璃体切割术患眼中，RBZ可改善脉络膜毛细血管血流。基线CVI可能与RBZ治疗后的视功能相关。ClinicalTrials.gov标识符：NCT04387604 。
