Department of Ophthalmology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Ophthalmic Res. 2024;67(1):96-106. doi: 10.1159/000535199. Epub 2024 Jan 11.
Objectives of the study were to investigate the correlation between optical coherence tomography (OCT)-based grading of diabetic macular edema (DME) and systemic inflammatory indices, imaging biomarkers, and early anti-vascular endothelial growth factor (VEGF) treatment response.
A total of 111 eyes from 111 patients with DME treated with intravitreous anti-VEGF therapy for 3 consecutive months every month were enrolled in this retrospective study. According to a protocol termed "TCED," DME was divided into early, advanced, severe, and atrophic stages. The best-corrected visual acuity (BCVA), subretinal fluid (SRF), and the number of hyperreflective foci (HRF) in the whole retinal layers were analyzed at baseline and 3 months after the first injection. Peripheral blood inflammatory indices were calculated, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet (PLT)-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and C-reactive protein (CRP). Statistical analysis was performed to compare the visual and anatomical results and evaluate HRF and SRF in different stages of DME before and after treatment.
There were significant differences in systemic inflammatory indices among the four groups, including NLR, PLR, MLR, SII, and CRP (all p < 0.05). The CRP, NLR, PLR, MLR, and SII were significantly higher in the atrophic stage compared to the advanced stage (all p < 0.05). Conversely, the CRP, NLR, PLR, MLR, and SII were significantly lower in the advanced stage compared to the early stage (all p < 0.05). Except for the atrophic stage, BCVA and central retinal thickness (CRT) were significantly improved after treatment in early, advanced and severe stages (all p < 0.05), especially in the severe stage. The decline in the proportion of SRF and HRF ≥20 was the most significant in the advanced stage after anti-VEGF treatment (p < 0.001, p = 0.016), but not in the early and severe stages (all p > 0.05).
Systemic inflammatory indices and the decline in the proportion of SRF and HRF ≥20 were closely associated with different stages of DME based on "TCED." Meanwhile, the "TCED" grading system can predict visual and anatomical prognosis of DME after anti-VEGF treatment, which may be a biomarker for identifying risk stratification and management of DME.
本研究旨在探讨基于光学相干断层扫描（OCT）的糖尿病性黄斑水肿（DME）分级与全身炎症指标、影像学生物标志物和早期抗血管内皮生长因子（VEGF）治疗反应之间的相关性。
本回顾性研究共纳入 111 例 111 只眼的 DME 患者，这些患者每月接受 3 次玻璃体内抗 VEGF 治疗，连续治疗 3 个月。根据一项名为“TCED”的方案，DME 分为早期、进展期、严重期和萎缩期。在基线和第一次注射后 3 个月时，分析最佳矫正视力（BCVA）、视网膜下液（SRF）和整个视网膜层的高反射焦点（HRF）数量。计算外周血炎症指标，包括中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）和 C 反应蛋白（CRP）。比较不同分期 DME 治疗前后的视觉和解剖结果，并评估 HRF 和 SRF。
四组之间的全身炎症指数存在显著差异，包括 NLR、PLR、MLR、SII 和 CRP（均 p < 0.05）。与进展期相比，萎缩期的 CRP、NLR、PLR、MLR 和 SII 均显著升高（均 p < 0.05）。相反，与早期相比，进展期的 CRP、NLR、PLR、MLR 和 SII 均显著降低（均 p < 0.05）。除了萎缩期外，早期、进展期和严重期的 BCVA 和中心视网膜厚度（CRT）在治疗后均显著改善（均 p < 0.05），尤其是严重期。抗 VEGF 治疗后，进展期 SRF 和 HRF≥20 的比例下降最为显著（p < 0.001，p = 0.016），但在早期和严重期则不显著（均 p > 0.05）。
基于“TCED”，全身炎症指标和 SRF 及 HRF≥20 的比例下降与 DME 的不同分期密切相关。同时，“TCED”分级系统可以预测 DME 患者抗 VEGF 治疗后的视觉和解剖学预后，可能是识别 DME 风险分层和管理的生物标志物。
