糖尿病性黄斑水肿OCT参数与视力预后的相关性分析  

Correlation analysis on the OCT parameters and visual prognosis of diabetic macular edema

作　　者：吴大霞 裴明杭 万光明[1] Wu Daxia;Pei Minghang;Wan Guangming(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2022年第6期406-411,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家自然科学基金资助项目(81970842)。

摘　　要：目的分析糖尿病性黄斑水肿(DME)患者初诊时OCT参数与治疗后最终视力的相关性。方法回顾性病例系列研究。收集郑州大学第一附属医院2019年9月至2021年10月玻璃体内注射抗血管内皮细胞生长因子(VEGF)药物治疗的DME 99例(137只眼)的临床资料,分析DME早期OCT参数变化与治疗后最终视力的相关性。治疗后随访≥6个月。结果本研究患者初诊DME黄斑中心区厚度(CMT)为(354.96±208.50)μm。线性相关分析表明,发病初期CMT、视网膜外界膜损伤范围及椭圆体带损伤范围三者与患者末次随访视力呈显著相关(r=0.29、0.19、0.26,P=0.001、0.025、0.002)。与治疗后视力较好的患眼相比,视力较差的患眼初诊CMT更高(Z=-3.61,P<0.001),外界膜损伤范围更大(Z=-2.60,P=0.009),表现为浆液性视网膜脱离的患眼比例更高(χ^(2)=5.72,P=0.017)。通过将OCT各指标和混杂因素共同纳入多因素Logistic回归模型发现,初诊时高CMT是最终视力差的独立危险因素。结论DME早期OCT参数与治疗后最终视力具有相关性,初次发病时较高的CMT可作为患者治疗后最终视力差的预测指标。Objective To analyze the correlation between OCT parameters at first visit and the visual outcome after treatments of diabetic macular edema(DME)patients.Methods This was a retrospective case series study.The clinical data of 137 eyes of 99 patients with DME who received intravitreal injection of anti-VEGF drugs from Sep.2019 to Oct.2021 in the First Affiliated Hospital of Zhengzhou University were collected.Correlation analysis was conducted on changes of early OCT parameters and final visual acuity of DME patients after treatment.The follow-up time was≥6 months after treatment.Results The mean central macular thickness(CMT)of DME was(354.96±208.50)μm at baseline visit.Correlation analysis revealed that CMT,external limiting membrane(ELM)damage and ellipsoid zone damage at baseline visit were significantly correlated with the visual outcome of DME patients(r=0.29,0.26,0.19;P=0.001,0.002,0.025).Compared with the better visual outcome group,the worse visual outcome group showed higher CMT(Z=-3.61,P<0.001),wider ELM disruption dimension(Z=-2.60,P=0.009),and more cases of serous retinal detachment(χ^(2)=5.72,P=0.017).And multivariate logistic regression analysis with included confounding factors revealed that higher baseline CMT was an independent risk factor for worse visual outcome in DME patients.Conclusion Early relevant parameters of OCT in patients with DME are significantly correlated with visual outcome.High CMT at diagnosis can be used as a predictive factor for worse visual outcome in eyes with DME.

关 键 词：糖尿病视网膜病变 黄斑水肿 玻璃体内注射 血管内皮生长因子A 视力 

分 类 号：R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]