重复抗VEGF治疗对DME患者玻璃体黄斑界面的影响及其危险因素

Effect of repeated anti-vascular endothelial growth factor therapy on the vitreomacular interface in patients with diabetic macular edema and its risk factors

摘要:

目的：探讨糖尿病性黄斑水肿(DME)患者重复接受玻璃体腔注射抗血管内皮生长因子(VEGF)治疗对玻璃体黄斑界面(VMI)的影响及其相关危险因素。

方法：回顾性分析2018-01/2021-12于遵义市第一人民医院眼科接受玻璃体腔注射康柏西普治疗(3+PRN)的DME患者31例55眼的临床资料。比较发生VMI改变(VMI改变组，9例13眼)和未发生VMI改变(VMI无改变组，22例42眼)的患者治疗前后最佳矫正视力(BCVA)、中央视网膜厚度(CRT)、中心凹下脉络膜厚度(CCT)情况，并分析发生VMI改变的危险因素。

结果：纳入患者平均随访9.58±8.32mo，平均接受抗VEGF治疗4.07±2.17次，且VMI改变组患者玻璃体腔注射次数多于VMI无改变组(5.77±2.09次 vs 3.55±1.93次，P=0.001)。末次随访时，与治疗前相比，两组患者治疗后BCVA均显著改善(均P<0.05)，而CCT均无明显变化(均P>0.05)，VMI无改变组患者CRT显著减小(P=0.039)，但VMI改变组患者CRT未见明显变化(P=0.627)。Logistic回归分析结果显示，治疗前BCVA是VMI改变的危险因素(P=0.049，OR=6.210，95%CI 1.006～38.346)。

结论：DME患者反复玻璃体腔注射抗VEGF药物过程中可能发生VMI改变，治疗前BCVA越差的患者VMI发生改变的风险越高，且VMI改变的患者对抗VEGF治疗反应欠佳。

Abstract:

AIM: To investigate the effect of repeated intravitreal injection of anti-vascular endothelial growth factor(VEGF)on the vitreomacular interface(VMI)and its related risk factors in patients with diabetic macular edema(DME).

METHODS: The clinical data of 31 patients(55 eyes)with DME who received intravitreal injections of Conbercept(3+PRN)in the ophthalmology department of the First People's Hospital of Zunyi from January 2018 to December 2021 were analyzed retrospectively. There were 9 cases(13 eyes)in the group that has changes in VMI and 22 cases(42 eyes)in the other group that has no changes in VMI. The best corrected visual acuity(BCVA), central retinal thickness(CRT), and central choroidal thickness(CCT)of the two groups were compared, and the risk factors of VMI change were analyzed.

RESULTS: The patients were followed up for an average of 9.58±8.32mo, received an average of 4.07±2.17 times of anti-VEGF therapy, and the number of intravitreal injections in VMI changed group was more than that in VMI unchanged group(5.77±2.09 times vs. 3.55±1.93 times, P=0.001). At the last follow-up, compared with before treatment, the BCVA of both patients improved significantly after treatment(both P<0.05), while CCT had no significant change(both P>0.05). CRT of patients in the VMI unchanged group decreased significantly(P=0.039), but there was no significant change in patients of VMI changed group(P=0.627). Logistic regression analysis showed that BCVA was a risk factor for VMI change before treatment(P=0.049, OR=6.210, 95%CI 1.006～38.346).

CONCLUSIONS: The VMI of DME patients may change during repeated intravitreal injections of anti-VEGF drugs. The worse the BCVA before treatment, the higher the risk of change in VMI, and the patients with VMI change have a poor response to anti-VEGF treatment.