不同OCT分型糖尿病黄斑水肿临床治疗效果  

Comparison of therapeutic effect for diabetic macular edema based on different optical coherence tomography patterns

作　　者：比较 徐心雨 夏颖[1] 胡天明 魏伟[1] Xu Xinyu;Xia Ying;Hu Tianming;Wei Wei(Department of Ophthalmology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院眼科,210029

出　　处：《中华实验眼科杂志》2021年第11期975-981,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81774370)。

摘　　要：目的比较不同光相干断层扫描(OCT)分型糖尿病黄斑水肿(DME)患眼行玻璃体腔内注射雷珠单抗(IVR)和/或激光光凝治疗后的疗效差异。方法采用非随机对照临床研究方法,纳入2017年3月至2018年2月在南京中医药大学附属医院眼科确诊为DME的患者79例108眼,根据OCT形态特征将患眼分为弥漫性黄斑水肿(DRT)组41眼、黄斑囊样水肿(CME)组37眼和浆液性神经上皮层脱离(SRD)组30眼。根据诊疗指南给予患者单纯IVR治疗或IVR联合激光光凝治疗,分别于治疗前,治疗后1、3、6、12个月记录患眼BCVA和黄斑中心凹视网膜厚度(CMT),观察患眼黄斑水肿形态变化并记录并发症发生情况。结果治疗后1、3、6和12个月3个组患眼平均BCVA(LogMAR)均较治疗前显著提高,平均CMT均较治疗前显著降低,差异均有统计学意义(均P<0.05)。接受IVR治疗的39眼中,治疗后12个月,DRT组患眼平均BCVA(LogMAR)为0.41±0.40,显著优于CME组的0.60±0.40,差异有统计学意义(P=0.039);治疗后12个月,DRT组患眼平均CMT为(286.05±109.56)μm,显著小于SRD组的(338.30±101.87)μm,差异有统计学意义(P=0.045)。接受IVR联合激光光凝治疗的69眼中,治疗后6个月和12个月,DRT组患眼平均BCVA(LogMAR)显著优于CME组,差异均有统计学意义(P=0.048、0.043);治疗后12个月,DRT组患眼平均CMT为(304.59±106.66)μm,显著低于SRD组的(369.34±107.80)μm,差异有统计学意义(P=0.041)。随访过程中可见SRD患眼中5眼转变为DRT亚型,3眼转变为CME亚型,但未见DRT及CME亚型向SRD亚型转化者。结论IVR和/或激光光凝治疗可显著改善各不同OCT分型DME患者患眼BCVA,降低CMT,其中对DRT分型患者的疗效较好。Objective To evaluate the efficacy of intravitreal ranibizumab(IVR)injection and/or laser photocoagulation on diabetic macular edema(DME)of different morphologic patterns based on optical coherence tomography(OCT).Methods A non-randomized controlled clinical trial was conducted.A total of 79 diabetic patients(108 eyes)who were diagnosed as DME in Affiliated Hospital of Nanjing University of Chinese Medicine from March 2017 to February 2018 were enrolled.The subjects were divided into diffuse macular edema(DRT)group(41 eyes),cystoid macular edema(CME)group(37 eyes)and serous retinal detachment(SRD)group(30 eyes)according to the morphological characteristics of OCT,and received intravitreal injection of 0.05 ml(0.5 mg)ranibizumab and/or laser photocoagulation according to treatment guidelines.Best corrected visual acuity(BCVA),central macular thickness(CMT)of the subjects were recorded before treatment and 1 month,3,6 and 12 months after treatment.The morphologic changes of macular edema and complications were recorded.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Affiliated Hospital of Nanjing University of Chinese Medicine(No.2017NL-13-03).Written informed consent was obtained from each patient before any medical examination and treatment.Results The 1-,3-,6-and 12-month post-treatment average BCVA(LogMAR)of the DRT,CME and SRD groups were improved in comparison with before treatment,and the average CMT of the three groups at various time points after treatment was reduced than that before treatment(all at P<0.05).For the 39 eyes who received IVR treatment,the 12-month post-treatment average BCVA(LogMAR)of the DRT group was 0.41±0.40,which was significantly better than 0.60±0.40 of the CME group(P=0.039).The 12-month post-treatment CMT of the DRT group was(286.05±109.56)μm,which was significantly thinner than(338.30±101.87)μm of the SRD group(P=0.045).For the 69 eyes who received IVR combined with laser photocoagulation treatment,the 6-and 12-month pos

关 键 词：糖尿病视网膜病变/治疗 黄斑水肿 血管生成抑制剂 单克隆抗体 激光凝固术 光相干断层扫描 

分 类 号：R774.5[医药卫生—眼科] R587.2[医药卫生—临床医学]