玻璃体内注射雷珠单抗治疗重度非增生型糖尿病视网膜病变伴黄斑水肿后患者脉络膜厚度的变化

Changes of choroidal thickness after ranibizumab treatment for non-proliferative diabetic retinopathy with macular edema

目的观察玻璃体内注射雷珠单抗治疗重度非增生型糖尿病视网膜病变伴黄斑水肿后患者脉络膜厚度的变化情况,明确脉络膜厚度与患者视力之间的相关性。方法选取在我院确诊为重度非增生型糖尿病视网膜病变伴黄斑水肿患者23例(23眼),每月眼内注射1次雷珠单抗并连续接受3次治疗,记录患者治疗前以及治疗后1个月、2个月、3个月黄斑中心凹下脉络膜厚度,同时记录患者黄斑区视网膜神经上皮厚度和最佳矫正视力。分析黄斑中心凹下脉络膜厚度、黄斑区视网膜神经上皮厚度、最佳矫正视力的动态变化情况以及相关性。结果玻璃体内注射雷珠单抗后1个月、2个月、3个月黄斑中心凹下脉络膜厚度和黄斑区视网膜神经上皮厚度均连续下降,前两个月与治疗前相比两指标差异均无统计学意义(均为P>0.05),第3个月时与治疗前相比,差异均有统计学意义(P=0.04、0.01)。最佳矫正视力在治疗过程中持续得到改善,前两个月与治疗前相比差异均无统计学意义(均为P>0.05),第3个月时与治疗前相比,差异有统计学意义(P=0.04)。治疗前黄斑中心凹下脉络膜厚度与黄斑区视网膜神经上皮厚度之间存在正相关性(R^2=0.94,P=0.00);与治疗前和治疗后3个月最佳矫正视力之间均存在正相关性(R^2=0.93,P=0.00;R^2=0.82,P=0.00)。治疗前黄斑区视网膜神经上皮厚度与治疗后3个月最佳矫正视力之间也存在正相关性(R^2=0.83,P=0.00)。治疗前最佳矫正视力与治疗后3个月最佳矫正视力之间同样存在正相关性(R^2=0.84,P=0.00)。结论黄斑中心凹下脉络膜厚度可以作为评价重度非增生型糖尿病视网膜病变伴黄斑水肿病情变化的有效临床指标,而且可以一定程度上预测抗血管内皮生长因子治疗的效果。

Objective To observe the changes of choroidal thickness after ranibizumab treatment for non-proliferative diabetic retinopathy （NPDR） with macular edema,and determine the association between choroidal thickness and visual acuity.Methods Twenty-three eyes from 23 patients diagnosed with NPDR and diabetic macular edema were treated with 3 monthly intravitreal injections of ranibizumab.The subfoveal choroidal thickness and central macular thickness were measured,and the best corrected visual acuity was recorded.Changes of subfoveal choroidal thickness,correlation between subfoveal choroidal thickness and best corrected visual acuity were assessed at 3 months follow-up.Results After 3 monthly anti-VEGF treatments,subfoveal choroidal thickness and central macular thickness decreased significantly,there was no statistical difference at 1 month and 2 months compared with pre-treatment （all P〉0.05）,but there was statistical differences at 3 months compared with pre-treatment （P=0.04,0.01）.In the treatment,the best corrected visual acuity increased gradually,there was no statistical difference at 1 month and 2 months compared with pre-treatment （all P〉0.05）,but there was statistical differences at 3 months compared with pre-treatment （P=0.04）.Before the treatment,the subfoveal choroidal thickness was positive correlated with macular retinal thickness （R2=0.94,P=0.00）;And the best corrected visual acuity before treatment and 3 months after treatment had a positive correlation （R2=0.93,P=0.00;R2=0.82,P=0.00）.There was a positive correlation between central macular thickness and best corrected visual acuity at 3 months after treatment （R2=0.83,P=0.00）.There was a positive correlation in the best corrected visual acuity between before treatment and 3 months after treatment （R2=0.84,P=0.00）.Conclusion The subfoveal choroidal thickness is a clinical index to evaluate the efficacy of anti-VEGF in the treatment of diabetic macular edema.Baseline subfoveal choroidal thickness can be considered as one of the indicators of clinical efficacy in the short term.