Department of Vitreoretina, Lotus Eye Hospital and Institute, Coimbatore, TN, India.
Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA.
Eye (Lond). 2024 Dec;38(17):3272-3278. doi: 10.1038/s41433-024-03275-y. Epub 2024 Aug 3.
To understand subfoveal neurosensory detachment flattening and observe (SNF-Ob) strategy and its relationship with visual acuity in the management of centre-involved diabetic macular oedema (Ci-DMO).
This was a multicentric retrospective observational study. We reviewed data of 188 eyes of 130 patients who presented with Ci-DMO with subfoveal neurosensory detachment (NSD) and treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents or steroids. The primary outcome was best corrected visual acuity (BCVA) measured at the time of the first subfoveal neurosensory detachment flattening (SNF) and at the end of follow-up.
Eyes that achieved 20/50 (LogMAR = 0.40) or better at first SNF had mean LogMAR BCVA 0.38 ± 0.21, 0.24 ± 0.11 and 0.21 ± 0.15 at baseline, at the time of first SNF, and at the end of the last follow-up respectively. Mean LogMAR BCVA significantly improved from baseline to first SNF (p < 0.0001; 95% CI 0.115-0.183) and at the end of the last follow-up (p < 0.0001; 95% CI 0.126-0.213) with a change of Early Treatment Diabetic Retinopathy Study (ETDRS) 10 letters. There was no significant difference in improvement in BCVA from the first SNF and at the end of the last follow-up (p = 0.0781; 95% CI -0.002 to 0.046).
Eyes presenting with Ci-DMO and subfoveal NSD are unlikely to improve at SNF with BCVA > 20/50 (LogMAR = 0.40). Further evidence is needed before the combination of good BCVA and SNF may be considered as endpoint of pharmacological therapy for DMO.
了解中心性糖尿病黄斑水肿（Ci-DMO）伴中心凹下神经感觉层脱离（NSD）的黄斑下神经感觉层脱离平复（SNF-Ob）策略，并观察其与视力的关系。
这是一项多中心回顾性观察研究。我们回顾了 130 例 188 只眼的资料，这些患者均患有 Ci-DMO 伴中心凹下 NSD，并接受了玻璃体内抗血管内皮生长因子（anti-VEGF）药物或皮质类固醇治疗。主要结局是首次 SNF 时和随访结束时的最佳矫正视力（BCVA）。
首次 SNF 时达到 20/50（LogMAR=0.40）或更好的眼，其平均 LogMAR BCVA 在基线时、首次 SNF 时和最后一次随访时分别为 0.38±0.21、0.24±0.11 和 0.21±0.15。与基线相比，首次 SNF 时（p<0.0001；95%CI 0.115-0.183）和最后一次随访时（p<0.0001；95%CI 0.126-0.213）的平均 LogMAR BCVA 均显著改善，变化值为早期糖尿病视网膜病变治疗研究（ETDRS）10 个字母。从首次 SNF 到最后一次随访时，BCVA 的改善无显著差异（p=0.0781；95%CI -0.002 至 0.046）。
对于首次 SNF 时 BCVA>20/50（LogMAR=0.40）的 Ci-DMO 伴中心凹下 NSD 患者，黄斑下神经感觉层脱离难以平复，视力改善。在将良好的 BCVA 与 SNF 结合作为 DMO 药物治疗的终点之前，还需要进一步的证据。
