Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro," Bari, Italy.
Ophthalmology Department, Careggi University Hospital, University of Florence, Florence, Italy.
Invest Ophthalmol Vis Sci. 2024 Aug 1;65(10):6. doi: 10.1167/iovs.65.10.6.
To explore the long-term effect of diabetic retinopathy on response to anti-vascular endothelial growth factor (VEGF) treatment in age-related macular degeneration-associated type 1 macular neovascularization (MNV) using optical coherence tomography angiography (OCTA).
A total of 45 eyes with exudative neovascular age-related macular degeneration (nAMD) with type 1 MNV were included in the analysis. Among them, 24 eyes of 24 patients had no history of diabetes mellitus (DM) in their anamnesis and were assigned to the Not Diabetic group; 21 eyes of 21 patients had mild diabetic retinopathy and were included in the Diabetic group. We considered the following outcome measures: (1) best-corrected visual acuity changes; (2) central macular thickness; (3) MNV lesion area; and (4) MNV flow area. The OCTA acquisitions were performed at the following time points: (1) baseline visit, which corresponded to the day before the first injection; (2) post-loading phase (LP), which was scheduled at 1 month after the last LP injection; and (3) 12-month follow-up visit.
All morphofunctional parameters showed a significant improvement after the LP and at the 12-month follow-up visit. Specifically, both the Diabetic group and the Not Diabetic group displayed a significant reduction of MNV lesion areas at both the post-LP assessment (P = 0.026 and P = 0.016, respectively) and the 12-month follow-up (P = 0.039 and P = 0.025, respectively). Similarly, the MNV flow area was significantly decreased in both the Diabetic group and the Not Diabetic group at the post-LP assessment (P < 0.001 and P = 0.012, respectively) and at the 12-month follow-up (P = 0.01 and P = 0.035, respectively) compared to baseline. A smaller reduction in the MNV lesion area was observed in the Diabetic group at both the post-LP evaluation (P = 0.015) and the 12-month follow-up (P = 0.032). No other significant differences were found between the groups for the other parameters (P > 0.05).
Our results indicated that the Diabetic group exhibited a smaller reduction in MNV lesion area after 12 months of anti-VEGF treatment. This highlights the importance of considering diabetic retinopathy as a potential modifier of treatment outcomes in nAMD management, with DM serving as a crucial risk factor during anti-angiogenic treatment.
使用光相干断层扫描血管造影术（OCTA）探讨糖尿病视网膜病变对年龄相关性黄斑变性相关 1 型黄斑新生血管（MNV）患者对抗血管内皮生长因子（VEGF）治疗反应的长期影响。
共纳入 45 只患有渗出性新生血管性年龄相关性黄斑变性（nAMD）合并 1 型 MNV 的患眼。其中，24 只眼（24 例患者）既往病史中无糖尿病（DM），归入非糖尿病组（Not Diabetic 组）；21 只眼（21 例患者）患有轻度糖尿病性视网膜病变，归入糖尿病组（Diabetic 组）。我们观察了以下结果测量指标：（1）最佳矫正视力变化；（2）中心视网膜厚度；（3）MNV 病变面积；和（4）MNV 血流面积。OCTA 采集分别在以下时间点进行：（1）基线访视，即第一次注射前一天；（2）加载后阶段（LP），安排在最后一次 LP 注射后 1 个月；和（3）12 个月随访。
LP 后和 12 个月随访时，所有形态功能参数均有显著改善。具体而言，糖尿病组和非糖尿病组在 LP 后评估（P = 0.026 和 P = 0.016）和 12 个月随访时（P = 0.039 和 P = 0.025），MNV 病变面积均显著减小。同样，糖尿病组和非糖尿病组在 LP 后评估（P < 0.001 和 P = 0.012）和 12 个月随访时（P = 0.01 和 P = 0.035），MNV 血流面积均显著减少。糖尿病组在 LP 后评估（P = 0.015）和 12 个月随访时（P = 0.032），MNV 病变面积的减少幅度较小。两组在其他参数上无显著差异（P > 0.05）。
我们的结果表明，糖尿病组在抗 VEGF 治疗 12 个月后，MNV 病变面积的减少幅度较小。这凸显了将糖尿病视网膜病变视为 nAMD 管理中治疗结果潜在修饰因素的重要性，DM 是抗血管生成治疗期间的一个关键危险因素。
