抗血管内皮生长因子治疗糖尿病性黄斑水肿对视网膜外层结构恢复的效果

doi:10.3969/j.issn.1004-583X.2022.09.010

摘要/Abstract

摘要：

目的探讨玻璃体腔注射雷珠单抗(intravitreal ranibizumab, IVR)治疗糖尿病性黄斑水肿(diabetic macular edema, DME)过程中对视网膜外层结构完整性的恢复效果。方法回顾性观察我院24例(28眼)已确诊DME患者,所有患眼行玻璃体腔注射雷珠单抗0.05 ml,平均随访时间(8.21±1.56)个月。详细记录所有患眼治疗前后最佳矫正视力(BCVA),并换算为最小分辨角对数(logMAR)视力;SD-OCT仪分析所有患者治疗过程中黄斑区特征,包括黄斑中心凹视网膜厚度(central macular thickness,CMT)、视网膜外界膜(external limiting membrane,ELM)及光感受器椭圆体带(ellipsoid zone,EZ)完整性的变化。结果 28眼基线平均logMAR视力为1.38±0.21,首次注射后6个月的平均logMAR视力为0.39±0.08,治疗前后差异有统计学意义(P<0.05)。基线平均CMT为(416.36±23.10) μm,首次注射后6个月的平均CMT为(231.15±38.26) μm,治疗前后差异有统计学意义(P<0.05)。ELM完全缺失率由术前78.6%降至首次注射后6个月的10.7%;EZ带完全缺失率由术前71.4%降至首次注射后6个月的14.3%。术后6个月,BCVA与CMT(r=0.356,P<0.01)、ELM(r=0.589,P<0.01)及EZ(r=0.626,P<0.01)有强相关性。结论抗血管内皮生长因子(vascular endothelial growth factor, VEGF)治疗DME患者可恢复视网膜外层结构(ELM、EZ)完整性,从而提高视力;ELM恢复完整性早于EZ带。

关键词: 糖尿病, 黄斑水肿, 黄斑中央视网膜厚度, 外界膜, 椭圆体带, 光学相干断层成像技术

Abstract:

Objective To investigate the effect of intravitreal ranibizumab (IVR) injection on the restoration of outer retinal structural integrity in diabetic macular edema (DME). Methods In this retrospective study, totally 24 DME patients (28 eyes) were treated with intravitreal injections of 0.05ml ranibizumab with average time of follow-up was 8.21±1.56 months. Best corrected vision acuity (BCVA) of pre- and post-treatment was recorded in detail, which calibrated a logarithm of the minimal angle of resolution (logMAR) visual acuity chart in statistical analysis. Spectral domain optical coherence tomography (SD-OCT) was performed pre- and post-treatment. The characteristics of macular structural were statistically analyzed, including central macular thickness (CMT), the continuity of external limiting membrane (ELM) and ellipsoid zone (EZ).Results Mean logMAR VA of 28 eyes decreased after IVR therapy from 1.38±0.21 at baseline to 0.39±0.08 at 6 months after the first injection (P<0.05). Similarly, CMT reduced from (416.36±23.10)μm at baseline to (231.15±38.26) μm at 6 months after the first injection (P<0.05). Global ELM disruption reduced from 78.6% pre-treatment to 10.7% at 6 months after the first injection; likewise global EZ disruption reduced from 71.4% to 14.3%.There was a strong correlation between BCVA and CMT (r=0.356, P<0.01), the statuses of ELM (r=0.589, P<0.01) and EZ (r=0.626, P<0.01).Conclusion Anti-vascular endothelial growth factor (VEGF) therapy can restore the integrity of outer retinal structure (ELM, EZ) in DME patients, thus improving vision. ELM restoration preceds EZ restoration.

Key words: diabetes mellitus, macular edema, central macular thickness, external limiting membrane, ellipsoid zone, optical coherence tomography

中图分类号:

R774.5

薛鹏程, 刘增业, 武劲圆, 马诚. 抗血管内皮生长因子治疗糖尿病性黄斑水肿对视网膜外层结构恢复的效果[J]. 临床荟萃, 2022, 37(9): 817-821.

Xue Pengcheng, Liu Zengye, Wu Jinyuan, Ma Cheng. Effect of anti-vascular endothelial growth factor on outer retinal structure restoration of diabetic macular edema[J]. Clinical Focus, 2022, 37(9): 817-821.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.09.010

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I9/817

图/表 4

参考文献 23

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组别	例数	BCVA	CMT(μm)
基线	28	1.38±0.21	416.36±23.10
1 m	28	0.76±0.15^*	321.24±16.20^*
2 m	28	0.51±0.26^*	278.44±11.00^*
3 m	28	0.40±0.11^*	243.24±13.10^*
6 m	28	0.39±0.08^*	231.15±38.26^*
F值		4.365	5.146
P值		0.031	0.014

组别	例数	BCVA	CMT(μm)
基线	28	1.38±0.21	416.36±23.10
1 m	28	0.76±0.15^*	321.24±16.20^*
2 m	28	0.51±0.26^*	278.44±11.00^*
3 m	28	0.40±0.11^*	243.24±13.10^*
6 m	28	0.39±0.08^*	231.15±38.26^*
F值		4.365	5.146
P值		0.031	0.014

组别	例数	ELM连续眼数			EZ完整眼数
组别	例数	0级	1级	2级	0级	1级	2级
基线	28	1(3.6)	5(17.9)	22(78.6)	2(7.1)	6(21.4)	20(71.4)
1 m	28	4(14.3)	8(28.6)	16(57.1)	3(10.7)	7(25.0)	18(64.3)
2 m	28	12(42.9)^*	9(32.1)	7(25.0)^*	8(28.6)^*	8(28.6)	12(42.9)^*
3 m	28	18(64.3)^*	6(21.4)	4(14.3)^*	16(57.1)^*	7(25.0)	5(17.9)^*
6 m	28	20(71.4)^*	5(17.9)	3(10.7)^*	19(67.9)^*	5(17.9)	4(14.3)^*
P值		<0.01			<0.01

组别	例数	ELM连续眼数			EZ完整眼数
组别	例数	0级	1级	2级	0级	1级	2级
基线	28	1(3.6)	5(17.9)	22(78.6)	2(7.1)	6(21.4)	20(71.4)
1 m	28	4(14.3)	8(28.6)	16(57.1)	3(10.7)	7(25.0)	18(64.3)
2 m	28	12(42.9)^*	9(32.1)	7(25.0)^*	8(28.6)^*	8(28.6)	12(42.9)^*
3 m	28	18(64.3)^*	6(21.4)	4(14.3)^*	16(57.1)^*	7(25.0)	5(17.9)^*
6 m	28	20(71.4)^*	5(17.9)	3(10.7)^*	19(67.9)^*	5(17.9)	4(14.3)^*
P值		<0.01			<0.01