Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland.
Int J Mol Sci. 2022 Jul 8;23(14):7585. doi: 10.3390/ijms23147585.
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.
本研究旨在总结预测生物标志物，以指导 DME 的治疗选择。玻璃体内抗 VEGF 治疗被认为是 DME 治疗中心的金标准治疗方法，而玻璃体内皮质类固醇治疗已被确立为 DME 的二线治疗方法。然而，尽管进行了多达每周 4 次的注射，超过 1/3 的患者对抗 VEGF 治疗反应不足。毫不奇怪，抗 VEGF 治疗反应不足与血清和房水中的 VEGF 水平正常偏低有关。这些患者可能会从早期转为玻璃体内皮质类固醇治疗中受益。在这些患者中，OCT 可见的形态学生物标志物可预测治疗反应并指导治疗决策。即，存在大量视网膜和脉络膜高反射灶、外视网膜层中断以及其他慢性迹象，例如延伸到外视网膜的视网膜内囊肿和较低的脉络膜血管指数，这些都是皮质类固醇治疗反应良好的迹象，与抗 VEGF 相比。本文总结了 DME 中的预测生物标志物，以帮助 DME 中的个体化治疗决策。这些标志物将有助于识别可能受益于首剂量地塞米松治疗或早期转换的 DME 患者。
