Evaluation of outer retinal tubulations in diabetic macular edema underwent anti-VEGF treatment

• 作者: Ling Hong Qin Ding Xiao Chen Xiao-Li Huang Yan-Ping Song
• 来源期刊: 国际眼科杂志:英文版
• 学科: 医学
• 关键词: outer RETINAL TABULATION diabetic MACULAR EDEMA SPECTRAL-DOMAIN optical coherence tomography anti-vascular endothelial growth factor
• 年，卷（期）: 2019,（3）
• 页码范围: 442-450
• 页数: 9页
• 分类号: R587.2

摘要

AIM: To investigate the incidence and subsequent changes of outer retinal tubulations(ORTs) in diabetic macular edema(DME) underwent anti-vascular endothelial growth factor(VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy.METHODS: This retrospective and descriptive study included a total of 228 patients(435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography(SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS: ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer(ONL), outer plexiform layer(OPL) and/or inner nuclear layer(INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyeswith variant ORTs(P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity(BCVA) and more BCVA change than those eyes with ORTs in DME patients after antiVEGF therapy(P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs(P=0.013). The proportion of stable vision in eyes with ORTs was significantly high