OCT 分级系统对中心性视网膜或半侧视网膜静脉阻塞患者的视力预测：SCORE2 的二次分析
OCT Grading System of Macular Infarction Predicts Vision in Participants With Central Retinal or Hemiretinal Vein Occlusion: A Secondary Analysis of SCORE2.
机构信息
Stein Eye Institute (A.A., D.S.), University of California, Los Angeles, California, USA.
Doheny Image Reading Center (M.I.), Doheny Eye Institute, Los Angeles, California, USA.
出版信息
Am J Ophthalmol. 2023 Dec;256:55-62. doi: 10.1016/j.ajo.2023.07.028. Epub 2023 Aug 5.
PURPOSE
To determine whether macular infarction measured as hyper-reflectivity of the middle and inner retinal layers predicts long-term visual acuity outcomes in participants with central retinal vein occlusion (CRVO) or hemi-retinal vein occlusion (HRVO).
DESIGN
Clinical cohort study using post hoc secondary analysis of phase 3 clinical trial data.
METHODS
This post hoc secondary analysis of the phase 3 Study of COmparative Treatments for REtinal Vein Occlusions 2 (SCORE2) clinical trial included 310 of the 362 participants with macular edema secondary to CRVO/HRVO who were randomized to injections of aflibercept or bevacizumab. Month 01 (M01) optical coherence tomography (OCT) images were analyzed using the following grading scheme: no infarction (grade 0), only middle retinal infarction (grade 1), diffuse middle and patchy inner retinal infarction (grade 2), and diffuse middle and inner retinal infarction (grade 3). Visual acuity letter score (VALS), central subfield thickness (CST), and number of anti-vascular endothelial growth factor (anti-VEGF) injections were correlated with the infarction severity grade at month 01.
RESULTS
More severe macular infarction, with both middle and inner retinal layer hyper-reflectivity (ie, grades 2 and 3), was associated with worse M00 VALS and was predictive of VALS at M01 to M60 (P < .001). More severe infarction was associated with greater CST at presentation; however, after the first anti-VEGF injection, CST decreased and was similar across all grades at all time points (P > .05) with similar number of injections.
CONCLUSIONS
Participants with more severe macular infarction at M01, as graded with OCT, exhibited worse visual outcomes despite significantly improved macular edema from month 6 to 5 years. This suggests that macular infarction may drive visual acuity after retinal fluid is treated with anti-VEGF.
目的
确定作为中层和内层视网膜高反射的黄斑梗死是否可预测视网膜中央静脉阻塞（CRVO）或半侧视网膜静脉阻塞（HRVO）患者的长期视力结果。
设计
使用 3 期临床试验数据的事后二次分析进行临床队列研究。
方法
这是对 3 期 COmparative Treatments for REtinal Vein Occlusions 2（SCORE2）临床试验的事后二次分析，包括 362 例继发于 CRVO/HRVO 的黄斑水肿患者中的 310 例，他们被随机分配接受阿柏西普或贝伐单抗注射。在第 1 个月（M01）光学相干断层扫描（OCT）图像中，使用以下分级方案进行分析：无梗死（0 级）、仅中层视网膜梗死（1 级）、弥漫性中层和斑片状内层梗死（2 级）和弥漫性中层和内层梗死（3 级）。视力字母评分（VALS）、中央视网膜神经纤维层厚度（CST）和抗血管内皮生长因子（抗 VEGF）注射次数与 M01 时的梗死严重程度分级相关。
结果
中层和内层视网膜高反射（即 2 级和 3 级）更严重的黄斑梗死与 M00VALS 更差相关，并且可预测 M01 至 M60 的 VALS（P <.001）。更严重的梗死与发病时 CST 较大相关；然而，在第一次抗 VEGF 注射后，CST 下降，并且在所有时间点的所有等级中均相似（P >.05），注射次数也相似。
结论
在 M01 时，OCT 分级显示更严重的黄斑梗死的患者尽管从第 6 个月到 5 年内黄斑水肿明显改善，但视力结果仍较差。这表明，在用抗 VEGF 治疗视网膜液后，黄斑梗死可能会影响视力。
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