摘要目的 观察不同光相干断层扫描(OCT)分型糖尿病黄斑水肿(DME)玻璃体腔注射雷珠单抗(IVR)的疗效差异及患眼椭圆体带完整性与视力的相关性.方法 接受IVR治疗的有临床意义的DME 85只眼纳入研究.采用早期治疗糖尿病视网膜病变研究视力表检测患眼最佳矫正视力(BCVA),统计分析时换算为最小分辨角对数(logMAR)视力;频域OCT仪测量患眼黄斑中心凹视网膜厚度(CFT),并通过OCT灰度图观察患眼椭圆体带的完整性.根据OCT形态特征将DME分为弥漫性黄斑水肿(DRT)、囊样黄斑水肿(CME)、浆液性视网膜脱离(SRD)3种类型并以此分组,分别为31、29、25只眼.所有患眼行玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml(含雷珠单抗0.5 mg)治疗.治疗后平均随访时间(9.21±3.56)个月.以治疗后3、6、12个月为疗效判定时间点,对比分析3组患眼BCVA、CFT及椭圆体带完整性的差异.按视力分段交叉比较,分析治疗前后不同BCVA分段患眼的椭圆体带完整性是否存在差异.结果 治疗后3、6、12个月患眼平均logMAR BCVA与治疗前比较,除SRD组患眼治疗后12个月logMAR BCVA较治疗前无明显变化之外(t=2.104,P=0.053),DRT组(t=7.847、6.771、6.426,P=0.000、0.000、0.000)、CME组(t=8.560、6.680、5.082,P=0.000、0.000、0.000)、SRD组(t=5.161、3.968,P=0.000、0.001)患眼治疗后其余时间平均logMAR BCVA均较治疗前明显提高,差异有统计学意义.治疗后12个月,DRT组患眼平均logMARBCVA较CME组、SRD组均降低,差异有统计学意义(t=-2.043、-3.434,P=0.030、0.001).治疗后3、6、12个月,DRT组(t=12.746、10.687、9.425,P=0.000、0.000、0.000)、CME组(t=13.400、11.460、10.169,P=0.000、0.000、0.000)、SRD组(t=1 1.755、10.100、9.173,P=0.000、0.000、0.000)患眼平均CFT均较治疗前明显降低,差异有统计学意义.治疗后12个月,SRD组患眼平均CFT较DRT组、CME组增高,差异有统计学意义(t=-3.251、-1.227,P=0.003、0.025);3组患眼椭圆体带存在的眼数比较,差异无统计学意义(x2=1.267,P=0.531).视力分段交叉比较结果显示,治疗前及治疗后12个月不同BCVA分段患眼椭圆体带完整性存在差异(x2=20.145、41.035,P=0.000、0.000).结论 IVR可明显改善不同OCT分型DME患眼的视力,降低CFT;其中DRT疗效最为突出.DME患眼椭圆体带完整性与视力相关.

abstractsObjective To observe the efficacy of intravitreal injection of ranibizumab (IVR) for different patterns of optical coherence tomography (OCT) of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes.Methods Eighty-five IVR treated eyes were enrolled.The examination of BCVA was according to Early Treatment Diabetic Retinopathy Study,and the results were recorded as logarithm of the minimum angle of resolution (logMAR).Frequency-domain OCT was used to measure the central foveal thickness (CFT) and the integrity of ellipsoidal zone.All eyes were classified as diffuse macular edema (DRT group,31 eyes),cystoid macular edema (CME group,29 eyes),and serous retinal detachment (SRD group,25 eyes).All the patients were treated with intravitreal injection of 0.05 ml (0.5 mg) ranibizumab.The mean follow-up time was (9.21+3.56) months after IVR treatment.The changes of BCVA and CFT in 3 groups were compared and analyzed after 3,6 and 12 months.According to visual acuity at different ranges,the relationship between integrity of ellipsoidal zone and BCVA was analyzed.Results Compared with the average logMAR BCVA before treatment,except for 12 months after treatment in group SRD (t=2.104,P=0.053),the average logMAR BCVA after IVR at 3 months,6 months and 12 months improved in DRT group (t=7.847,6.771,6.426;P=0.000,0.000,0.000),CME group (t=8.560,6.680,5.082;P=0.000,0.000,0.000) and SRD group (t=5.161,3.968,2.104;P=0.000,0.001,0.053).The average logMAR BCVA of the DRT group was lesser than that in CME and SRD group after 12 months treatment (t=-2.043,-3.434;P=0.030,0.001).The average CFT after IVR at 3 months,6 months and 12 months reduced significantly in DRT group (t=12.746,10.687,9.425;P=0.000,0.000,0.000),CME group (t=13.400,11.460,10.169;P=0.000,0.000,0.000),and SRD group (t=1 1.755,10.100,9.173;P=0.000,0.000,0.000).After 12 months of treatment,the average CFT of the SRD group was thicker than that in DRT group and CME group (t=-3.251,-1.227;P=0.003,0.025);there was significant difference in the integrity of ellipsoidal zone among 3 groups (x2=1.267,P=0.531).The results showed that there were significant differences in the integrity of ellipsoidal zone with different ranges of BCVA before and after 12 months treatment (x2=20.145,41.035;P=0.000,0.000).Conclusions IVR could significantly improve the visual acuity of different patterns of DME,reduced the CFT,and had the best efficacy in the DRT group.There was relationship between the integrity of ellipsoidal zone and the visual acuity outcomes.