Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan.
Tokyo Rosai hospital Tokyo, Tokyo, Japan.
Medicine (Baltimore). 2023 Nov 3;102(44):e35888. doi: 10.1097/MD.0000000000035888.
Although anti-vascular endothelial growth factor (VEGF) treatment is effective for treating diabetic macular edema (DME), the effect of the microaneurysm (MA) status on the therapeutic efficacy of an anti-VEGF treatment remains unclear. Our current study investigated the effects of the number and the presence or absence of leaking MAs on DME and the efficacy of anti-VEGF therapy. A total of 51 eyes of 47 DME patients were administered anti-VEGF treatment. Fluorescence angiography results were used to determine the number of MAs and the presence or absence of leakage, with these findings matched to the optical coherence tomography maps. The correlation between the number of MAs and the retinal thicknesses and the influence of the leaking MAs was examined in order to definitively determine the effect of the anti-VEGF treatment. There was a correlation between the number of MAs and the retinal thickness of the sector in both the 6 mm (correlation coefficients: 0.42) and 3 mm (0.34) sectors (P < .001). There was also a correlation between the number of MAs and the retinal thickness in both the 6 mm (0.31) and 3 mm (0.24) sectors after undergoing the treatment (P < .01). There was a significant difference between the mean thickness of the leaking versus the non-leaking MAs in the 6 mm (388 ± 87 μm) and 3 mm (477 ± 108 μm) sectors before treatment (P < .01). There was also a significant difference for the retinal thickness between the sectors with and without leaking MAs after the treatment (P < .01). The degree of retinal edema before treatment is associated with the number of MAs and the presence of leaking MAs. Anti-VEGF treatment is less effective for focal macular edema with large numbers of MAs, which includes leaking MAs.
尽管抗血管内皮生长因子（VEGF）治疗对治疗糖尿病性黄斑水肿（DME）有效，但微动脉瘤（MA）状态对抗 VEGF 治疗效果的影响尚不清楚。本研究旨在探讨 MA 的数量及是否存在渗漏对 DME 及抗 VEGF 治疗效果的影响。对 47 例 DME 患者的 51 只眼进行抗 VEGF 治疗，荧光血管造影结果用于确定 MA 的数量和是否存在渗漏，并将这些发现与光学相干断层扫描图相匹配。检查 MA 的数量与视网膜厚度之间的相关性以及渗漏 MA 的影响，以明确抗 VEGF 治疗的效果。在 6mm（相关系数：0.42）和 3mm（0.34）扇区中，MA 的数量与视网膜厚度之间均存在相关性（P<0.001）。在治疗后，MA 的数量与 6mm（0.31）和 3mm（0.24）扇区的视网膜厚度之间也存在相关性（P<0.01）。在治疗前，6mm（388±87μm）和 3mm（477±108μm）扇区中，渗漏 MA 的平均厚度与非渗漏 MA 的平均厚度之间存在显著差异（P<0.01）。治疗后，有渗漏 MA 的扇区与无渗漏 MA 的扇区之间的视网膜厚度也存在显著差异（P<0.01）。治疗前视网膜水肿程度与 MA 的数量和存在渗漏 MA 有关。抗 VEGF 治疗对存在大量 MA，包括渗漏 MA 的局灶性黄斑水肿效果较差。
