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目的分析糖尿病黄斑水肿患者相干光断层扫描(OCT)中不同位置的高反射灶是否与视力预后相关,并观察抗VEGF治疗后OCT中高反射灶的变化情况。设计回顾性病例系列。研究对象2013年2月至2016年8月糖尿病黄斑水肿经抗血管内皮生长因子(VEGF)治疗的患者28例。方法所有入选病例在基线及末次访视时,均行最佳矫正视力、眼压、裂隙灯、间接检眼镜、彩色眼底照相、荧光素眼底血管造影及OCT检查。采用Heidelberg Spectralis OCT获得通过中心凹的黄斑区OCT图像,计数所扫范围内97幅B扫描中视网膜各层和玻璃体腔所有高反射灶的数量。平均随访(4.96±1.37)个月。分析不同位置高反射灶数量与视力预后的相关性。主要指标基线及末次随访的最佳矫正视力、中心视网膜厚度、视网膜各层高反射灶的数量、所扫玻璃体腔高反射灶数量与所扫玻璃体腔总面积的比值(RATIO)。结果内层视网膜中高反射灶数量为(156.00±118.76)个,外层视网膜为(3.79±5.25)个,RATIO为0.05±0.06。28眼(100%)均能在内层视网膜见到高反射灶,17眼(60.71%)在外层视网膜可见高反射灶。末次随访视力与基线期外层视网膜中高反射灶的数量呈明显的负相关(r=-0.506,P=0.006),与RATIO也呈负相关(r=0.462,P=0.013),而与内层视网膜中高反射灶的数量不相关(r=-0.163,P=0.408)。经抗VEGF治疗后内层视网膜及外层视网膜中高反射灶的数量均明显减少,而RATIO无明显变化。结论在经抗VEGF治疗的糖尿病黄斑水肿中,外层视网膜高反射灶的数量与视力预后呈明显负相关,而内层视网膜内高反射灶数量则与视力预后不相关。
Objective To analyze whether hyperreflexia in different locations of diabetic macular edema in patients with diabetic macular edema correlated with visual acuity prognosis and to observe the changes of hyperreflexia in OCT after anti-VEGF treatment. Design retrospective case series. Participants 28 patients with diabetic macular edema treated with anti-vascular endothelial growth factor (VEGF) from February 2013 to August 2016. Methods All selected cases underwent best corrected visual acuity, intraocular pressure, slit lamp, indirect ophthalmoscope, color fundus photography, fundus fluorescein angiography and OCT at baseline and last visit. OCT images of the macular area through the fovea were obtained using a Heidelberg Spectralis OCT and the number of all retina layers in the 97 B-scans and all of the high refractivity of the vitreous cavity in the swept range were counted. The average follow-up (4.96 ± 1.37) months. Analysis of the correlation between the number of high-reflex lesion and the prognosis of vision in different positions. The main indicators of the baseline and the last follow-up of the best corrected visual acuity, central retinal thickness, the number of high-reflex focal retina layers, the number of vitreous cavity reflex focal body and total vitreous cavity area ratio (RATIO). Results The number of high reflex foci in the inner retina was (156.00 ± 118.76), (3.79 ± 5.25) in the outer retina and 0.05 ± 0.06.28 eyes (100%) in the RATIO, all of which could be seen in the inner retina , 17 eyes (60.71%) in the outer retina visible high reflex foci. The final follow-up visual acuity was significantly negatively correlated with the number of hyperreflective foci in the outer retina at baseline (r = -0.506, P = 0.006) and negatively correlated with RATIO (r = 0.462, P = 0.013) The number of high-reflectivities in the retina was not correlated (r = -0.163, P = 0.408). After anti-VEGF treatment, the numbers of high reflex foci in the inner retina and outer retina were significantly reduced, while there was no significant change in RATIO. Conclusions In diabetic macular edema treated with anti-VEGF, the number of hyperreflective foci in the outer retina is significantly negatively correlated with the prognosis of visual acuity, while the number of hyperreflective foci in the inner retina is not related to the prognosis of visual acuity.