Szeto Simon Kh, Hui Vivian W K, Tang Fang Yao, Yang Dawei, Sun Zi Han, Mohamed Shaheeda, Chan Carmen K M, Lai Timothy Y Y, Cheung Carol
Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong.
Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong.
Br J Ophthalmol. 2023 Apr;107(4):525-533. doi: 10.1136/bjophthalmol-2021-319587. Epub 2021 Nov 8.
BACKGROUND/AIMS: To determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections.
This is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid.
The presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness.
Baseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO.
背景/目的：确定基于频域光学相干断层扫描（SD-OCT）的生物标志物的基线值与变化值相结合能否预测接受抗血管内皮生长因子（VEGF）注射治疗的糖尿病性黄斑水肿（DMO）患者的视力预后。
这是一项在中国香港进行的回顾性队列研究。招募了196例累及中心凹的DMO患者，这些患者在2011年1月1日至2018年6月30日期间接受了抗VEGF注射。回顾性检索参与者的病历，获取基线、6个月、12个月和24个月时的视力（VA）以及抗VEGF治疗开始前和结束后的SD-OCT检查结果。对SD-OCT图像进行评估，观察DMO的形态、玻璃体黄斑状态、视网膜内层紊乱（DRIL）情况、视网膜内囊肿大小、外界膜（ELM）、椭圆体带（EZ）和锥体外段顶端（COST）的可见性，以及视网膜或脉络膜内高反射灶的存在情况。
基线时存在DRIL、视网膜内高反射灶以及ELM/EZ和COST的破坏与治疗后长达24个月时较差的基线及后续视力相关。治疗后DRIL（p=0.048）、ELM/EZ（p=0.001）和COST（p=0.002）破坏情况的改善与12个月时视力的更大改善相关。黄斑囊样水肿形态（p=0.003，OR=8.18）和浆液性视网膜脱离形态（p=0.011，OR=4.84）的患者更有可能实现中心子野厚度至少降低20%。
基线SD-OCT生物标志物及其后续变化可预测接受抗VEGF注射治疗的DMO患者的视力及视力改善情况。我们提出了一种基于SD-OCT的系统，该系统可在实际眼科诊所中轻松使用，以改善DMO管理中的决策制定。
