1 型糖尿病患者糖尿病性黄斑水肿中观察、黄斑激光和抗 VEGF 治疗的视力结果：一项真实世界研究。
Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study.
机构信息
Department of Ophthalmology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, OYS, Finland.
PEDEGO Research Unit, University of Oulu, Oulu, Finland.
出版信息
BMC Ophthalmol. 2022 Jun 9;22(1):258. doi: 10.1186/s12886-022-02482-z.
BACKGROUND
The treatment for diabetic macular edema (DME) has revolutionized during the last 15 years after the introduction of intravitreal anti-VEGF agents. The aim of the current study is to evaluate the real-world visual outcomes of diabetic macular edema (DME) treatment in patients with type 1 diabetes (T1D) in long-term follow-up.
METHODS
A real-world, descriptive, population-based cohort and follow-up of all patients with T1D and DME in 2006-2020 in 34 communities of the Northern Ostrobothnia Hospital District. The main outcome measures included age, gender, duration of T1D at the onset of DME, stage of retinopathy, treatment of DME (observation, laser, intravitreal treatments, combination), and visual outcomes.
RESULTS
A total of 304 eyes of 206 T1D patients with DME were included. 75% (n=155) had non-proliferative diabetic retinopathy during the onset of DME. 15% of the cases were observed, 33% had macular laser, 41% intravitreal anti-VEGF and 12% combination of laser and intravitreal injections. Patients in anti-VEGF and in combination groups gained 4.9 and 5.5 ETDRS letters after the initial DME episode (p<0.001 and p<0.001), and the long-term visual improvements were 4.1 and 5.1 ETDRS letters (p<0.001 and p<0.001), respectively. In observation and laser groups the initial gain of 0.1 (p>0.90) and loss of 0.4 ETDRS letter (p=0.61), respectively, was noted. After the follow-up, a 3.7 ETDRS letter decrease was documented in the observation group (p>0.90) and a 1.1 (p=0.14) ETDRS letter decline in the laser group of patients. At the beginning of treatment, eyes subjected to anti-VEGF alone or in combination with laser had lower visual acuity compared to eyes subjected to observation or macular laser. The average of a 6.1±4.8 anti-VEGF injections were needed to dry DME. Visual impairment due to DME decreased from 2.4% to 1.0% during the 15-year period.
CONCLUSIONS
Anti-VEGF alone or in combination with macular laser seems to be beneficial in terms of visual outcomes and treatment stability in T1D patients with central DME. Moreover, satisfying long-term visual outcomes were achieved with anti-VEGF treatment in a real-world setting.
背景
在引入玻璃体内抗血管内皮生长因子（VEGF）药物治疗后，糖尿病性黄斑水肿（DME）的治疗在过去 15 年发生了革命性变化。本研究旨在评估 1 型糖尿病（T1D）患者长期随访中 DME 治疗的真实世界视觉结局。
方法
对 2006 年至 2020 年期间，在北奥斯特罗波的尼亚医院区 34 个社区中所有患有 T1D 和 DME 的患者进行真实世界、描述性、基于人群的队列和随访。主要观察指标包括年龄、性别、DME 发病时 T1D 的持续时间、视网膜病变阶段、DME 的治疗（观察、激光、玻璃体内治疗、联合治疗）和视力结果。
结果
共纳入 206 例 T1D 合并 DME 患者的 304 只眼。75%（n=155）在 DME 发病时患有非增殖性糖尿病性视网膜病变。15%的病例接受观察，33%接受黄斑激光治疗，41%接受玻璃体内抗 VEGF 治疗，12%接受激光联合玻璃体内注射治疗。初次 DME 发作后，抗 VEGF 组和联合组患者分别获得 4.9 和 5.5 个 ETDRS 字母（p<0.001 和 p<0.001），长期视力改善分别为 4.1 和 5.1 个 ETDRS 字母（p<0.001 和 p<0.001）。在观察组和激光组中，分别记录到初次获得 0.1 个（p>0.90）和损失 0.4 个 ETDRS 字母（p=0.61）。随访后，观察组 ETDRS 字母下降 3.7 个（p>0.90），激光组患者下降 1.1 个（p=0.14）。在开始治疗时，单独接受抗 VEGF 或联合激光治疗的眼与接受观察或黄斑激光治疗的眼相比，视力较差。平均需要 6.1±4.8 次抗 VEGF 注射才能使 DME 干燥。在 15 年期间，由于 DME 导致的视力损害从 2.4%下降到 1.0%。
结论
在 T1D 合并中心 DME 患者中，单独使用抗 VEGF 或联合黄斑激光治疗在视力结局和治疗稳定性方面似乎是有益的。此外，在真实世界环境中，抗 VEGF 治疗可实现令人满意的长期视力结局。
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