Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin 300384, China.
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin 300384, China.
Photodiagnosis Photodyn Ther. 2023 Jun;42:103555. doi: 10.1016/j.pdpdt.2023.103555. Epub 2023 Apr 23.
PURPOSE: To evaluate the effect of vitreomacular interface (VMI) configuration on treatment outcomes after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) using optical coherence tomography (OCT). METHODS: A systematic literature search was performed on PubMed, Embase, web of science and clinicaltrials.gov. The primary outcome parameters were central macular thickness (CMT), best-corrected visual acuity (BCVA) and mean injection numbers. We performed this meta-analysis by Review Manager (RevMan) 5.4.1. RESULTS: The impact of epiretinal membrane (ERM), vitreomacular traction (VMT) and vitreomacular adhesion (VMA) on the treatment outcomes were analyzed separately. 9 clinical studies involving 699 eyes were eligible for the meta-analysis for evaluating the effect of ERM/VMT on efficacy. And 7 studies with 610 eyes were included to access whether VMA affected the response to anti-VEGF therapy in patients with DME. The ERM/VMT group had poorer CMT reductions than the control group at 1 month ([MD] 52.91 mm, P<0.00001), while no significant difference at 3 months ([MD] 43.95 mm, P = 0.22) and over 12 months ([MD] 30.51 mm, P = 0.45). No statistically significant difference in the mean BCVA change at 1 month ([MD] -0.03 Log MAR, P = 0.79), whereas ERM/VMT group had poor visual acuity gains at 3 months ([MD] 0.08 Log MAR, P = 0.003), and a tendency of poor vision improvement over 12 months follow-up ([MD] 0.07 Log MAR, P = 0.11). There was no significant difference in the visual and anatomical results over 3 months in DME patients with or without VMA ([MD] -21.92 mm, P = 0.09; [MD] 1.79 letters, P = 0.22). Besides, VMI configuration was not found to affect mean injection numbers. CONCLUSION: The limited evidence suggested that ERM/VMT was associated with worse CMT reduction at 1 month, poor BCVA gain at 3 months and a tendency of limited vision improvement over 12 months follow-up in DME patients treated with anti-VEGF agents. And VMA may not adversely affect the anatomic and functional outcomes. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs.
目的：利用光学相干断层扫描（OCT）评估糖尿病性黄斑水肿（DME）患者玻璃体黄斑界面（VMI）形态对玻璃体腔内抗血管内皮生长因子（抗-VEGF）治疗后疗效的影响。
方法：对 PubMed、Embase、Web of Science 和 ClinicalTrials.gov 进行系统文献检索。主要观察指标为黄斑中心视网膜厚度（CMT）、最佳矫正视力（BCVA）和平均注射次数。采用 Review Manager（RevMan）5.4.1 进行荟萃分析。
结果：分别分析了内界膜（ERM）、玻璃体黄斑牵引（VMT）和玻璃体黄斑粘连（VMA）对治疗结果的影响。共有 9 项临床研究涉及 699 只眼符合纳入标准，用于评估 ERM/VMT 对疗效的影响。7 项研究纳入 610 只眼，用于评估 VMA 是否影响 DME 患者对抗 VEGF 治疗的反应。ERM/VMT 组在治疗 1 个月时的 CMT 降低程度较对照组差[MD 52.91 mm，P<0.00001]，而在治疗 3 个月时[MD 43.95 mm，P=0.22]和 12 个月时[MD 30.51 mm，P=0.45]无显著差异。ERM/VMT 组在治疗 1 个月时的平均 BCVA 变化无统计学意义[MD -0.03 LogMAR，P=0.79]，但在治疗 3 个月时视力提高较差[MD 0.08 LogMAR，P=0.003]，且在 12 个月随访时视力改善趋势较差[MD 0.07 LogMAR，P=0.11]。DME 患者无论是否存在 VMA，在治疗 3 个月时的视力和解剖结果均无显著差异[MD -21.92 mm，P=0.09；MD 1.79 个字母，P=0.22]。此外，VMI 形态未发现对平均注射次数有影响。
结论：有限的证据表明，ERM/VMT 与抗 VEGF 治疗的 DME 患者在治疗后 1 个月时 CMT 降低程度更差、3 个月时 BCVA 提高较差以及 12 个月随访时视力改善程度有限有关。VMA 可能不会对解剖和功能结果产生不利影响。然而，由于研究设计的异质性，本荟萃分析的结果应谨慎解释。
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