Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey.
Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey.
Int Ophthalmol. 2022 Nov;42(11):3579-3588. doi: 10.1007/s10792-022-02374-7. Epub 2022 Jun 23.
Analysis of foveal avascular zone (FAZ) width and vascular density (VD) changes before and after intravitreal dexamethasone implant (IDI) treatment in diabetic macular edema (DME) patients resistant to anti-VEGF treatment.
In this retrospective study, patients who were regularly treated with at least 5 doses of intravitreal Anti-VEGF (bevacizumab, ranibizumab or aflibercept) for DME and whose DME continued were considered resistant to Anti-VEGF and were treated with IDI for the first time. Thirty-four eyes of 34 patients were included in the study. FAZ and VD values of optical coherence tomography angiography (OCT-A) scans at 0, 1 and 3 months were examined.
In OCT-A measurements, the pre-IDI superficial plexus FAZ (SFAZ) area (0.350 ± 0.120 mm) was decreased at 1 (0.292 ± 0.132 mm, p < 0.001) and at 3 months (0.311 ± 0.153 mm, p = 0.017). Pre-IDI deep plexus FAZ (DFAZ) area (0.651 ± 0.313 mm) was decreased at 1-month post-IDI (0.481 ± 0.247 mm, p < 0.001) while no significant change was observed at 3 months (0.575 ± 0.259 mm, p = 0.197). There was no significant change in the mean post-IDI total VD rate in both superficial (pre 39.2% ± 2.4; 1st month 39.2% ± 2.6%; 3rd month 39.5% ± 3.4%) and deep retinal plexus (pre 43.3% ± 2.6%; 1st month 43.5 ± 2.8%; 3rd month 43.6% ± 4.6%) (p = 0.408 and p = 0.607, respectively).
The study showed that IDI caused a significant decrease in the FAZ area without any change in VD in patients with DME resistant to the anti-VEGF agents. IDI might be related to a decrease in the macular ischemia secondary to diabetic retinopathy.
分析玻璃体内注射地塞米松植入物（IDI）治疗对接受抗血管内皮生长因子（Anti-VEGF）治疗抵抗的糖尿病性黄斑水肿（DME）患者的中心凹无血管区（FAZ）宽度和血管密度（VD）变化。
在这项回顾性研究中，对至少接受 5 次玻璃体内抗 VEGF（贝伐单抗、雷珠单抗或阿柏西普）治疗的 DME 患者进行研究，这些患者的 DME 持续存在且对 Anti-VEGF 治疗有抵抗，他们首次接受了 IDI 治疗。本研究纳入了 34 例 34 只眼的患者。对光学相干断层扫描血管造影（OCT-A）扫描在 0、1 和 3 个月时的 FAZ 和 VD 值进行了检查。
在 OCT-A 测量中，IDI 前浅层脉络膜 FAZ（SFAZ）面积（0.350±0.120mm）在 1 个月时（0.292±0.132mm，p<0.001）和 3 个月时（0.311±0.153mm，p=0.017）降低。IDI 前深层脉络膜 FAZ（DFAZ）面积（0.651±0.313mm）在 1 个月时（0.481±0.247mm，p<0.001）降低，而在 3 个月时无明显变化（0.575±0.259mm，p=0.197）。浅层（预 39.2%±2.4；1 个月 39.2%±2.6%；3 个月 39.5%±3.4%）和深层视网膜脉络膜（预 43.3%±2.6%；1 个月 43.5%±2.8%；3 个月 43.6%±4.6%）的平均 IDI 后总 VD 率均无显著变化（p=0.408 和 p=0.607）。
该研究表明，IDI 导致 DME 患者 FAZ 面积显著减小，而对 VD 无影响，这可能与糖尿病性视网膜病变引起的黄斑缺血减少有关。
