Save Sight Institute, The University of Sydney, New South Wales, Australia; Sydney Hospital and Sydney Eye Hospital, New South Wales, Australia.
Save Sight Institute, The University of Sydney, New South Wales, Australia.
Ophthalmol Retina. 2022 Jul;6(7):540-547. doi: 10.1016/j.oret.2022.03.007. Epub 2022 Mar 17.
To investigate the incidence, characteristics, and baseline predictors of poor visual outcomes in eyes with diabetic macular edema (DME) receiving intravitreal therapy in routine clinical practice.
Observational study.
Treatment-naïve eyes starting intravitreal therapy for DME between 2014 and 2018 tracked in the Fight Retinal Blindness! registry. We examined 2 groups with poor visual outcomes: (1) those with sustained vision loss of > 10 letters from baseline without recovery of visual acuity (VA); and (2) those with a VA of < 55 letters at 2 years. Respective controls were eyes that did not experience poor visual outcomes.
Kaplan-Meier curves analyzed the proportion of eyes that experienced poor outcomes. Cox proportional hazards models evaluated the potential baseline predictors of poor outcomes.
The proportion of eyes that experienced poor visual outcomes within 2 years of treatment initiation and its baseline predictors.
The proportion of eyes with sustained VA of ≥ 10 letter loss was 14% at 2 years; 16% of eyes had VA of ≤ 55 letters 2 years after starting intravitreal therapy. Initial treatment with intravitreal corticosteroid was independently associated with a higher incidence of ≥ 10 letter loss (hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.60-6.44; P < 0.01). No improvement in the VA at 3 months after starting treatment was associated with ≥ 10 letter loss (HR, 6.81; 95% CI, 4.11-11.27; P < 0.01) and VA of ≤ 55 letters at 2 years (HR, 4.28; 95% CI, 2.66-6.89; P < 0.01). The other factors related to higher risk of VA of ≤ 55 letters were older age (HR, 1.02 per year; 95% CI, 1-1.04; P = 0.04) and poor baseline VA (HR, 0.68 per 5 letters; 95% CI, 0.65-0.72, P < 0.001).
Fourteen percent of eyes managed with intravitreal therapy in routine clinical care experienced ≥ 10 letter loss and 16% had VA of ≤55 letters 2 years after starting the treatment for DME. The identification of the incidence and predictors of poor outcomes provides a more accurate assessment of the potential benefit from intravitreal therapy.
在常规临床实践中，研究接受玻璃体内治疗的糖尿病性黄斑水肿（DME）患者视力不良结局的发生率、特征和基线预测因素。
观察性研究。
2014 年至 2018 年期间在 Fight Retinal Blindness！登记处开始接受 DME 玻璃体内治疗的未经治疗的初治眼。我们检查了两组视力不良结局患者：（1）从基线开始视力持续丧失> 10 个字母而无视力恢复（VA）；（2）在 2 年内 VA<55 个字母。相应的对照组为未出现视力不良结局的眼睛。
Kaplan-Meier 曲线分析了出现视力不良结局的眼睛比例。Cox 比例风险模型评估了视力不良结局的潜在基线预测因素。
治疗开始后 2 年内出现视力不良结局的眼睛比例及其基线预测因素。
在 2 年内，VA 持续丧失≥10 个字母的比例为 14%；16%的眼睛在开始玻璃体内治疗 2 年后 VA≤55 个字母。初始玻璃体内皮质类固醇治疗与更高的≥10 个字母损失发生率独立相关（风险比[HR]，3.21；95%置信区间[CI]，1.60-6.44；P<0.01）。治疗开始后 3 个月 VA 无改善与≥10 个字母损失（HR，6.81；95%CI，4.11-11.27；P<0.01）和 2 年内 VA≤55 个字母（HR，4.28；95%CI，2.66-6.89；P<0.01）相关。与 VA≤55 个字母风险较高相关的其他因素包括年龄较大（HR，每年 1.02；95%CI，1-1.04；P=0.04）和基线 VA 较差（HR，每 5 个字母 0.68；95%CI，0.65-0.72，P<0.001）。
在常规临床护理中接受玻璃体内治疗的 14%的眼睛在开始治疗 DME 后 2 年内经历了≥10 个字母的视力丧失，16%的眼睛的 VA≤55 个字母。对不良结局发生率和预测因素的识别为玻璃体内治疗的潜在获益提供了更准确的评估。
