基于光学相干断层扫描的不同类型糖尿病性黄斑水肿对康柏西普的治疗反应

目的 观察基于光学相干断层扫描（OCT）的不同类型糖尿病性黄斑水肿（DME）对康柏西普的治疗反应，并分析可能影响治疗反应和效果的因素。方法 回顾性分析2019年2月~2021年2月于我院确诊为DME且按照1+PRN方案行玻璃体腔注射康柏西普治疗的患者65例76只眼的临床资料。根据OCT特征将其分为3种类型：囊样黄斑水肿（CME）28只眼，浆液性视网膜脱离（SRD）33只眼和弥漫性视网膜增厚（DRT）15只眼。观察并比较治疗前及首次治疗后3月时各组患眼最佳矫正视力（BCVA）、黄斑中心视网膜厚度（CRT）；比较不同类型DME的基线OCT特征并分析其与康柏西普治疗反应及效果的关系。结果 3种类型DME治疗后3月BCVA均较基线明显好转（P<0.05）。3种类型DME 治疗后3月CRT均明显低于基线（P<0.05）。基线视网膜外层高反射点（HF）数量、椭圆体带（EZ）中断比例在SRD组中最高（P<0.05）。基线视网膜外层HF与基线CRT、CRT改变量、治疗后CRT均相关（P<0.05）。基线外界膜（ELM）/EZ中断组较连续组基线视力更差、基线CRT更高，治疗后3月CRT改变量更大、BCVA更差（P<0.05）。结论 3种类型DME在接受玻璃体腔注射康柏西普治疗后，功能学指标BCVA和形态学指标CRT均得到明显改善，其中，SRD类型对康柏西普治疗的形态学反应最好，DRT类型的形态学反应相对较差。更多的基线外层HF可能预示着更好的形态学治疗反应。基线ELM/EZ中断则提示治疗后3月视力预后更差。

Treatment response to Conbercept of different types of diabetic macular edema classified based on optical coherence tomography

Objective To compare different types of diabetic macular edema (DME) classified based on optical coherence tomography (OCT) for their responses to Conbercept injection and analyze the factors that affect the treatment responses. Methods We retrospectively analyzed the clinical data of 65 patients (76 eyes) with DME diagnosed and treated with intravitreal injection of Conbercept (1+PRN) in our hospital from February, 2019 to February, 2021. According to OCT findings, DME in these patients was classified into cystic macular edema (CME; 28 eyes), serous retinal detachment (SRD; 33 eyes), and diffuse retinal thickening (DRT; 15 eyes). The best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and at 3 months after the first treatment. The baseline OCT characteristics of different types of DME were compared, and the correlation of these OCT characteristics with the treatment response to Conbercept was analyzed. Results All the patients showed significant improvement of the BCVA 3 months after the treatment (P<0.05). For all the 3 types of DME, the CRT at 3 months after the first treatment was significantly reduced as compared to the baseline (P<0.05). The number of hyperreflective foci (HF) in the outer retina and the proportion of ellipsoid zone (EZ) interruption were the greatest in SRD group (P<0.05). The baseline outer retinal HF was significantly correlated with the baseline CRT, CRT changes and CRT after treatment (all P<0.05). The patients with baseline outer limiting membrane (ELM)/ EZ disruption had poorer baseline BCVA, greater baseline CRT, greater variation of CRT and poorer BCVA at 3 months after treatment (all P<0.05). Conclusion For all the 3 types of DME, treatment with intravitreal injection of Conbercept can significantly improve the BCVA and CRT of the patients. DME of the SRD type has the best morphological response to Conbercept, while the DRT type has a relatively poor response. A greater number of HF at baseline may indicate a better morphological response to Conbercept treatment, and baseline ELM/EZ disruption may suggest a poor visual prognosis at 3 months after treatment.