Chen Nan-Ni, Lai Chien-Hsiung, Lee Chai-Yi, Kuo Chien-Neng, Chen Ching-Lung, Huang Jou-Chen, Wu Pei-Chen, Wu Pei-Lun, Chen Chau-Yin
Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan.
Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan.
J Pers Med. 2022 Apr 11;12(4):611. doi: 10.3390/jpm12040611.
(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112-36.623, = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment.
（1）背景：研究玻璃体内注射雷珠单抗（IVIR）治疗糖尿病性黄斑水肿（DME）后治疗效果与形态学变化之间的相关性。（2）方法：这项回顾性研究纳入了228只接受IVIR治疗DME的眼睛。每位参与者在首次IVIR后随访两年，同时收集眼科检查、光学相干断层扫描（OCT）图像和全身疾病的数据。根据OCT形态学变化的存在情况和初始OCT形态学模式，将研究人群分为不同亚组，包括弥漫性视网膜增厚（DRT）、黄斑囊样水肿（CME）、浆液性视网膜脱离（SRD）和玻璃体黄斑界面异常（VMIA）。主要结局指标为两年研究期间的基线最佳矫正视力（BCVA）和中心黄斑厚度（CMT）。分析OCT形态学变化的分布及其与主要结局的关系。（3）结果：将42只（18.4%）有OCT形态学变化的眼睛与另外186只（81.6%）无此类改变的眼睛进行比较，前者的基线BCVA较差（0.84±0.39对0.71±0.36，P = 0.035），最终BCVA更差（0.99±0.44对0.67±0.30，P = 0.001），最终CMT更厚（354.21±89.02对305.33±83.05，P = 0.001）。此外，在所有DME患者中，14.9%出现了VMIA，这是DRT、CME和SRD中最常见的形态学变化。此外，中风的存在与形态学变化独立相关（调整后的优势比[aOR]：6.381，95%置信区间[CI]：1.112 - 36.623，P = 0.038）。（4）结论：接受IVIR治疗的DME患者OCT形态学变化与较差的结构和视觉结局相关，而VMIA的形成最常发生在初始治疗后。
