Department of Ophthalmology of Tongji Hospital and Laboratory of Clinical and Visual Sciences of Tongji Eye Institute, Tongji University School of Medicine, Shanghai, China.
Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.
Ophthalmic Res. 2023;66(1):39-47. doi: 10.1159/000525412. Epub 2022 Jun 13.
Objectives of the study were to describe the hyperreflective foci (HRF) on optical coherence tomography angiography in diabetic macular edema (DME) with subretinal fluid (SRF) and explore the association of HRF in the outer retina with photoreceptor integrity and visual outcomes after anti-vascular endothelial growth factor (anti-VEGF) treatment.
We retrospectively reviewed 46 eyes (36 patients) with DME treated with anti-VEGF drugs. The following parameters, including best-corrected visual acuity (BCVA), central macular thickness (CMT), the height of SRF, the number of HRF in the superficial capillary plexus, deep capillary plexus, and the outer retina, as well as the integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), were evaluated and compared between the baseline and after 2 monthly injections of anti-VEGF drugs. The relationship between the HRF in the outer retina and the integrity of ELM and EZ, as well as BCVA, was analyzed.
BCVA was significantly improved in DME after anti-VEGF treatment; however, for the subgroup of DME patients with SRF, visual acuity remained unchanged after anti-VEGF treatment (p < 0.05 vs. p = 0.375). The number of HRF (p < 0.05), CMT (p < 0.001), and SRF height (p < 0.001) were significantly reduced, accompanied with partial restoration of ELM and EZ integrity after anti-VEGF injection. The HRF in the outer retina was correlated with the final ELM (p = 0.036) and EZ (p = 0.004) status. The final BCVA was significantly better in eyes with intact ELM (p = 0.002) and EZ at final visit (p < 0.001).
The number of HRF in outer retina was negatively associated with the microstructural restoration of ELM and EZ, as well as the visual outcome in DME patients with SRF after anti-VEGF treatment.
本研究的目的是描述伴有视网膜下液（SRF）的糖尿病性黄斑水肿（DME）的光相干断层扫描血管造影中的高反射焦点（HRF），并探讨外层视网膜中的 HRF 与光感受器完整性以及抗血管内皮生长因子（anti-VEGF）治疗后的视力结果之间的关系。
我们回顾性分析了 46 只眼（36 例）接受抗 VEGF 药物治疗的 DME 患者。评估并比较了基线时和接受 2 个月抗 VEGF 药物治疗后的最佳矫正视力（BCVA）、中心黄斑厚度（CMT）、SRF 高度、浅层毛细血管丛、深层毛细血管丛和外层视网膜中的 HRF 数量以及外节膜（ELM）和椭圆体带（EZ）的完整性。分析了外层视网膜中的 HRF 与 ELM 和 EZ 的完整性以及 BCVA 之间的关系。
抗 VEGF 治疗后 DME 的 BCVA 显著提高；然而，对于伴有 SRF 的 DME 患者亚组，抗 VEGF 治疗后视力仍未改变（p<0.05 与 p=0.375）。HRF 数量（p<0.05）、CMT（p<0.001）和 SRF 高度（p<0.001）显著降低，抗 VEGF 注射后 ELM 和 EZ 完整性部分恢复。外层视网膜中的 HRF 与最终 ELM（p=0.036）和 EZ（p=0.004）状态相关。最终 ELM 完整（p=0.002）和最终 EZ 完整（p<0.001）的眼的最终 BCVA 显著更好。
伴有 SRF 的 DME 患者接受抗 VEGF 治疗后，外层视网膜中的 HRF 数量与 ELM 和 EZ 的微观结构恢复以及视力结果呈负相关。
