抗VEGF治疗对不同类型DME患者黄斑中心凹无血管区的影响

目的 基于糖尿病性黄斑水肿(DME)的不同影像类型，采用OCTA探讨DME患者抗血管内皮生长因子(VEGF)治疗前后黄斑中心凹无血管区(FAZ)结构的变化。方法 回顾性分析2019年10月至2021年10月来我院就诊的经3+PRN抗VEGF治疗的51例62眼DME患者资料。根据黄斑水肿类型分为弥漫增厚型DME(DRT-DME)组30例(36眼)和黄斑囊样水肿型DME(CME-DME)组21例(26眼)。分别收集两组患者抗VEGF治疗前、治疗后3个月及治疗后6个月的临床资料和OCTA指标，包括最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、FAZ面积、黄斑中心凹旁300μm范围内的视网膜血流密度(FD)和FAZ非圆度指数(AI),并对其进行比较分析。对CME-DME组患者抗VEGF治疗前后OCTA指标差值(治疗前与治疗后6个月差值)之间的相关性采用Spearman相关性分析。结果 与治疗前相比，DRT-DME组患者治疗后3个月和治疗后6个月各方位的CRT均下降、BCVA均改善(均为P<0.05),但FAZ面积、FD和AI的差异均无统计学意义(均为P>0.05)。与治...

Effect of anti-vascular endothelial growth factor therapy on the foveal avascular zone in patients with different types of diabetic macular edema

Objective　To observe the structural changes of the foveal avascular zone (FAZ) in patients with different imaging types of diabetic macular edema (DME) before and after the anti-vascular endothelial growth factor (anti-VEGF) therapy by using optical coherence tomography angiography (OCTA).
Methods　The clinical data of 51 DME patients (62 eyes) who were treated with 3+PRN anti-VEGF in our hospital from October 2019 to October 2021 were enrolled in this retrospective study. According to the type of macular edema, all patients were divided into diffuse retinal thickening diabetic macular edema (DRT-DME) group (30 patients, 36 eyes) and cystoid macular edema diabetic macular edema (CME-DME) group (21 patients, 26 eyes). The clinical data and OCTA indexes of patients in the two groups before treatment, 3 months and 6 months after treatment were collected and analyzed, including best corrected visual acuity (BCVA), central retinal thickness (CRT), FAZ area, flow density (FD) within the range of 300 μm beside the FAZ and acircularity index (AI) of FAZ. The Spearman correlation analysis was carried out in the OCTA indexes before and 6 months after the anti-VEGF therapy in the CME-DME group.
Results　Compared with those before treatment, the CRT decreased and BCVA improved in the DRT-DME group both at 3 months and 6 months after treatment (all P<0.05), but there were no significant changes in FAZ area, FD and AI (all P>0.05). In the CME-DME group, the CRT, FAZ area and AI of patients significantly declined, and the BCVA and FD were remarkably improved 3 months and 6 months after treatment (all P<0.05). However, there was no significant difference in all parameters between 3 months and 6 months after treatment in the two groups (all P>0.05). The Spearman correlation analysis of these parameters before and after the anti-VEGF therapy in the CME-DME group(△=values before the therapy-values at 6 months after the therapy) showed that the △FAZ area was positively correlated with △AI (P<0.05), while △FD was negatively related to △FAZ area and △AI (both P<0.05). In addition, △CRT was positively correlated with △FAZ area and △AI while negatively associated with △FD (all P<0.05).
Conclusion　Anti-VEGF therapy has different influences on FAZ in different types of DME. It promotes the macular blood supply and the recovery of FAZ in patients with CME-DME, but it has no significant effect on DRT-DME patients. However, parafoveal retinal ischemia did not worsen during the follow-up period.