Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.
Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
Medicine (Baltimore). 2022 Aug 19;101(33):e30115. doi: 10.1097/MD.0000000000030115.
This study aimed to investigate the therapeutic effect of cataract surgery along with simultaneous intravitreal injection (IVI) of aflibercept on diabetic macular edema (DME). This cohort study enrolled 106 patients aged >40 years with type 2 diabetes mellitus and DME who received cataract surgery from January 1, 2016, to October 31, 2020. The baseline and mean data of the following parameters were collected: age, sex, glycated hemoglobin level, diabetic retinopathy (DR) grading, previous DR treatments including IVI of anti-vascular endothelial growth factor and pan-retinal photocoagulation, intraocular pressure, use of intraocular pressure-lowering medication, central subfield thickness (CST), and log MAR visual acuity (VA). Patients were categorized into 2 groups based on whether they received aflibercept IVI or not during cataract surgery and were compared using the t test and Fisher exact test for continuous and discrete variables, respectively. Beta coefficient and standard error were calculated using multiple linear regression analysis to identify the explanatory variables predictive of the net change of CST and log MAR VA. There was no difference in the net change in CST (15.24 ± 45.07 μm vs 18.62 ± 33.84 μm, P = .772) and log MAR VA (-0.27 ± 0.29 vs -0.37 ± 0.31, P = .215). Gender, glycated hemoglobin level, aflibercept IVI during cataract surgery, and baseline CST did not interfere with the morphological and functional outcomes of DME in cataract surgery. Older age was significantly and independently associated with a greater net change in log MAR VA. Proliferative DR was significantly and independently associated with a greater net change in CST and log MAR VA. A greater baseline log MAR VA was significantly and independently associated with lower net change in log MAR VA. Simultaneous aflibercept IVI for treating DME may not interfere with the functional and tomographic parameters of cataract surgery relative to cataract surgery alone. Factors influencing the outcomes of patients with DME undergoing cataract surgery are as follows: age, baseline DR staging, and baseline VA. Identifying these factors of DME preoperatively may be an important consideration in preventing it from progressing and for improving the overall visual prognosis.
本研究旨在探讨白内障手术联合玻璃体内注射（IVI）阿柏西普治疗糖尿病黄斑水肿（DME）的疗效。这项队列研究纳入了 2016 年 1 月 1 日至 2020 年 10 月 31 日期间接受白内障手术的年龄>40 岁的 2 型糖尿病伴 DME 患者 106 例。收集了以下参数的基线和平均值数据：年龄、性别、糖化血红蛋白水平、糖尿病视网膜病变（DR）分级、既往包括抗血管内皮生长因子 IVI 和全视网膜光凝在内的 DR 治疗、眼压、降眼压药物的使用、中心视网膜神经纤维层厚度（CST）和 logMAR 视力（VA）。根据患者在白内障手术期间是否接受阿柏西普 IVI 将其分为两组，并分别使用 t 检验和 Fisher 确切检验比较两组间的连续和离散变量。使用多元线性回归分析计算β系数和标准误差，以确定预测 CST 和 logMAR VA 净变化的解释变量。CST （15.24±45.07μm vs 18.62±33.84μm，P=0.772）和 logMAR VA （-0.27±0.29 vs -0.37±0.31，P=0.215）的净变化差异无统计学意义。性别、糖化血红蛋白水平、白内障手术期间接受阿柏西普 IVI 以及基线 CST 并不影响白内障手术中 DME 的形态和功能结局。年龄较大与 logMAR VA 的净变化显著相关。增殖性 DR 与 CST 和 logMAR VA 的净变化显著相关。基线 logMAR VA 较高与 logMAR VA 的净变化较低显著相关。与单纯白内障手术相比，同时进行阿柏西普 IVI 治疗 DME 可能不会影响白内障手术的功能和断层参数。影响 DME 患者白内障手术结局的因素如下：年龄、基线 DR 分期和基线 VA。术前识别这些 DME 因素可能是预防其进展和改善整体视觉预后的重要考虑因素。
