Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui 910-1193, Japan.
Medicina (Kaunas). 2022 Jul 14;58(7):933. doi: 10.3390/medicina58070933.
Background and Objectives: The presence of refractory cases resistant to anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) is a problem in clinical practice. This study aimed to explore the less responsive area of optical coherence tomography (OCT) 3D map the characteristics of naïve DME cases after their first anti-VEGF. Materials and Methods: In 46 patients with DME who received an intravitreal injection of anti-VEGF agents, retinal thickness in 100 sections of the macular area was measured by 3D-mapping mode using OCT before and 1 month after injection. The density of the microaneurysm (MA) was calculated using merged images of the OCT map and fluorescein angiography. Results: One month after injection, the central retinal thickness significantly decreased (p < 0.0001). In severe edema (retinal thickness more than 500 µm), the area percentages with a reduction rate of the retinal thickness greater than 30% and less than 5% were 6.4 ± 6.6% and 10.1 ± 4.6%, respectively. The reduction rate of the retinal thickness varied from section to section. The mutual distance between the areas of maximum thickness before and after the injection averaged 1.22 ± 0.62 mm apart. The reduction rate of retinal thickness in the thickest region before injection was significantly higher (p = 0.02), and that in the thickest region after injection was lower (p = 0.001) than in the other regions. MA density in the residual edema was significantly higher than in the edema-absorbed area (p = 0.03). Conclusion: DME has areas that show low response to the reduction in retinal thickness with anti-VEGF therapy. A high density of MA may be associated with this pathogenesis.
对于糖尿病黄斑水肿（DME）患者，存在对血管内皮生长因子（VEGF）治疗产生抗药性的难治性病例，这是临床实践中的一个问题。本研究旨在探讨首次接受抗 VEGF 治疗后，对 OCT 3D 地图中 naïve DME 病例反应不佳区域的特征。
在 46 例接受抗 VEGF 药物玻璃体内注射的 DME 患者中，使用 OCT 的 3D 映射模式测量黄斑区 100 个节段的视网膜厚度，在注射前和注射后 1 个月进行测量。使用 OCT 地图和荧光素血管造影的合并图像计算微动脉瘤（MA）的密度。
注射后 1 个月，中央视网膜厚度显著降低（p < 0.0001）。在严重水肿（视网膜厚度大于 500 µm）中，视网膜厚度减少率大于 30%且小于 5%的区域百分比分别为 6.4 ± 6.6%和 10.1 ± 4.6%。视网膜厚度的减少率在各个节段之间存在差异。注射前后最大厚度区域之间的相互距离平均为 1.22 ± 0.62 mm。注射前最厚区域的视网膜厚度减少率明显更高（p = 0.02），而注射后最厚区域的视网膜厚度减少率更低（p = 0.001）。残留水肿中的 MA 密度明显高于水肿吸收区域（p = 0.03）。
DME 存在对减少抗 VEGF 治疗后视网膜厚度反应不佳的区域。MA 密度高可能与这种发病机制有关。
