疫情期间中断抗VEGF治疗导致DME患者视力不提高的原因及OCT影像学分析

Reasons for not improving visual acuity of DME patients due to interruption of anti-VEGF therapy during the pandemic and OCT imaging analysis

目的:分析因新型冠状病毒肺炎疫情中断治疗后糖尿病性黄斑水肿(DME)患者再次行抗血管内皮生长因子(VEGF)治疗患者视力不提高的原因以及与OCT影像学特征的相关性。方法:回顾性病例研究。选择2019-12/2020-07于西安交通大学第一附属医院眼科行抗VEGF药物治疗的DME患者31例40眼,纳入患者均有因新冠疫情中断治疗的病史,根据再次治疗后1mo最佳矫正视力(BCVA)提高1行为标准分为视力提高组14眼和视力不提高组26眼。所有患者均接受全面的眼科检查,包括BCVA、眼压、光学相关断层扫描(OCT)、眼底照相和眼底荧光血管造影(FFA),使用Image J软件对黄斑OCT图像中的中央视网膜厚度(CRT)、高反射物质(HRD)、视网膜下液(SRF)、视网膜内低反射囊腔(IRF)、视网膜内层结构紊乱(DRIL)和椭圆体带破坏(EZD)进行量化分析。采用Sperman相关分析治疗后1mo BCVA与CRT、HRD数量、SRF和IRF的直径与高度DRIL和EZD宽度之间的相关性。结果:视力不提高组患者OCT中HRD出现的比例明显高于视力提高组(χ^(2)=5.43,P=0.0072);DME患者经治疗前后BCVA(LogMAR)差值与CRT差值呈正相关(r_(s)=0.406,P=0.009),治疗后BCVA(LogMAR)与治疗后EZD宽度呈正相关(r_(s)=0.358,P=0.023)。治疗后BCVA(LogMAR)分别与治疗后CRT(r_(s)=-0.086,P=0.600)、HRD数量(r_(s)=-0.115,P=0.482)、SRF的直径与高度(r_(s)=0.102,P=0.530;r_(s)=0.100,P=0.538)、IRF的直径与高度(r_(s)=0.134,P=0.410;r_(s)=-0.014,P=0.932)以及DRIL宽度(r_(s)=0.089,P=0.587)之间无相关性。结论:因为新冠疫情中断治疗后再次行抗VEGF治疗视力无提高的患者出现视网膜HRD的概率明显高于视力提高的患者,EZD宽度也与预后视力密切相关,针对此类患者可综合OCT中HRD表现,必要时玻璃体腔注射糖皮质激素抗炎作为辅助策略。

AIM:To identify the reasons for not improving visual acuity of patients with diabetic macular edema(DME)and its correlation with optical coherent tomography(OCT)imaging characteristics.They were treated with anti-vascular endothelial growth factor(VEGF)again after an interruption of treatment due to the COVID-19 pandemic.METHODS:Retrospective cases study.A total of 31 patients(40 eyes)with DME and treated with anti-VEGF drugs in the Department of Ophthalmology of the First Affiliated Hospital of Xi'an Jiaotong University between December 2019 and July 2020 were selected.All patients had an treatment history of interruption due to COVID-19.Based on the behavioral standard of best corrected visual acuity(BCVA)at 1mo after re-treatment,they were divided into improved visual acuity group(14 eyes)and non-improved visual acuity group(26 eyes).All patients received comprehensive ophthalmic examinations,including BCVA,intraocular pressure,OCT,fundus photography,and fundus fluorescein angiography(FFA).The central retinal thickness(CRT),hyper-reflective retinal dots(HRD),subretinal fluid(SRF),intraretinal fluid(IRF),disorganization of the inner retinal layers(DRIL)and ellipsoid zone disruption(EZD)were quantified by Image J.The correlation between BCVA and CRT,the number of HRD,the diameter of SRF and IRF,and the height of DRIL and EDZ width at 1mo after treatment were analyzed by Spearman correlation.RESULTS:The proportion of HRD in OCT was significantly higher in the non-improved visual acuity group than that in the improved visual acuity group(χ^(2)=5.43,P=0.0072);There was a positive correlation between the difference of BCVA(LogMAR)and CRT change in DME patients after treatment(r_(s)=0.406,P=0.009);There was a positive correlation between BCVA(LogMAR)and EZD width after treatment(r_(s)=0.358,P=0.023).There was no correlation between BCVA(LogMAR)after treatment and the number of CRT(r_(s)=-0.086,P=0.600)and HRD(r_(s)=-0.115,P=0.482),the diameter and height of SRF(r_(s)=0.102,P=0.530;r_(s)=0.100,P=0.538)and IRF(r_(s)=0.134,P=0.410;r_(s)=-0.014,P=0.932),and the width of DRIL(r_(s)=0.089,P=0.587).CONCLUSION:The probability of retinal HRD was significantly higher in patients with no visual improvement than that in patients with visual improvement after the re-treatment with anti-VEGF due to the treatment interruption during COVID-19.EZD width was also closely correlated to the prognosis of visual acuity.As for these patients,HRD manifestations in OCT should be comprehensively considered,taking intravitreal injection of glucocorticoid as an auxiliary strategy if necessary.