Baseline OCT Biomarkers Associated with Visual Acuity in Diabetic Macular Edema: A Systematic Review and Meta-analysis.

IF 9.5 1区医学 Q1 OPHTHALMOLOGY

Ophthalmology Pub Date : 2025-08-11 DOI:10.1016/j.ophtha.2025.07.038

Keean Nanji, Justin Grad, Amin Hatamnejad, Abdullah El-Sayes, Andrew Mihalache, Mohamed Gemae, Ryan Huang, Mark Phillips, Peter K Kaiser, Marion R Munk, Sunir J Garg, David Sarraf, SriniVas R Sadda, Samantha Fraser-Bell, Dena Zeraatkar, Jinhui Ma, Enrico Borrelli, David H Steel, Sobha Sivaprasad, Charles C Wykoff, Varun Chaudhary

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引用次数: 0

Abstract

Topic: To determine effect estimates and certainty of evidence for the associations between baseline OCT biomarkers and (1) patient visual acuity (VA) and (2) changes in VA from baseline to 6, 12, and 24 months after initiation of anti-vascular endothelial growth factor, steroid, or laser treatment for diabetic macular edema.

Clinical relevance: Understanding the prognostic value conferred by biomarkers can help predict disease activity and inform treatment decisions.

Methods: This review was registered in the International Prospective Register of Systematic Reviews (identifier, CRD42023487798). Ovid MEDLINE, EMBASE, and CENTRAL databases were searched. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines informed certainty of evidence.

Results: Twenty-eight reports from 27 studies evaluating 75 biomarkers were included. No biomarker with at least a moderate certainty was associated with improved VA or change in VA. Results are reported in Early Treatment Diabetic Retinopathy Study letters. Five biomarkers were associated with reduced VA at 2 or more time points with moderate certainty: (1) hyperreflective retinal foci (HRF; 6 months, -6.5 [95% confidence interval (CI), -10.4 to -2.6]; 12 months, -7.3 [95% CI, -11.6 to -3.0], (2) hyperreflective choroidal foci (HCF; 6 months, -7.3 [95% CI, -13.3 to -1.3]; 12 months, -7.5 [95% CI, -11.9 to -3.0], (3) disorganization of retinal inner layers (DRIL; 6 months, -6.0 [95% CI, -11.7 to -0.3]; 12 months, -7.3 [95% CI, -12.8 to -1.7], (4) disrupted ellipsoid zone (EZ) or external limiting membrane (ELM; 6 months, -9.7 [95% CI, -15.4 to -3.9]; 12 months, -7.5 [95% CI, -11.9 to -3.0]; 12 months isolated EZ disruption, -5.4; [95% CI, -9.2 to -1.6] ; 24 months, -9.0 [95% CI, -14.3 to -3.6], and (5) disrupted cone outer segment termination (COST) line (12 months, -8.5 [95% CI, -13.5 to -3.5]; 24 months, -8.8 [95% CI, -14.0 to -3.6].

Discussion: Baseline HRF, HCF, DRIL, disrupted EZ or ELM, and disrupted COST lines were associated with worse VA at 2 or more time points with moderate certainty of evidence. Greater standardization in biomarker classification and better control of confounding variables are needed.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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基线光学相干断层扫描生物标志物与糖尿病黄斑水肿的视力相关：一项系统综述和荟萃分析。

目的：确定基线光学相干断层扫描（OCT）生物标志物与(1)患者的视力（VA）和(2)抗血管内皮生长因子、类固醇或激光治疗糖尿病黄斑水肿后从基线到6、12和24个月的VA变化之间相关性的效应估计和证据的确定性。临床相关性：了解生物标志物赋予的预后价值可以帮助预测疾病活动并为治疗决策提供信息。方法：本综述在PROSPERO注册（CRD42023487798）。检索了Ovid MEDLINE、EMBASE和CENTRAL数据库。QUIPS工具告知了偏倚风险评估，GRADE指南告知了证据的确定性。结果：纳入了27项研究的28篇报告，评估了75种生物标志物。没有至少“中等”确定性的生物标志物与VA的改善或VA的改变相关。结果：早期治疗糖尿病视网膜病变研究（ETDRS）快报报道。五种生物标志物与两个或更多时间点的VA降低相关，具有“中度”确定性：(i)高反射性视网膜灶（HRF）(6个月：-6.5；95% CI: -10.4 ~ -2.6；1项研究（196只眼）；12个月：-7.3；95% CI: -11.6 ~ -3.0；1项研究（196只眼睛）),（ii）高反射性脉络膜灶（HCF）(6个月：-7.3；95% CI: -13.3 ~ -1.3；1项研究（196只眼）；12个月:-7.5;95%CI: -11.9 ~ -3.0；1项研究（196眼）)（iii）视网膜内层紊乱（DRIL）(6个月：-6.0；95% CI:-11.7 ~ -0.3；1项研究（196只眼）；12个月:-7.3;95%CI:-12.8至-1.7；1项研究（196只眼睛）),（iv）破坏椭球区（EZ）或外限制膜（ELM）(6个月：-9.7；95%CI: -15.4 ~ -3.9；1项研究（196只眼）；12个月:-7.5;95%CI:-11.9 ~ -3.0；1项研究（196只眼）；12个月孤立性EZ干扰：-5.4；95%CI:-9.2 ~ -1.6；2项研究（263只眼睛）；I2: 0%;24个月:-9.0;95%CI:-14.3 ~ -3.6；1项研究（196只眼睛）)和(v)锥体外段终止（COST）线(12个月：-8.5；95%CI:-13.5 ~ -3.5；1项研究（196只眼）；24个月：-8.8；95%CI: -14.0 ~ -3.6；1项研究（196只眼睛）)。结论：基线HRF、HCF、DRIL、中断的EZ或ELM以及中断的COST线在两个或多个时间点与较差的VA相关，具有“中度”确定性。生物标记物分类需要更大的标准化和更好的混杂变量控制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ophthalmology 医学-眼科学

CiteScore

22.30

自引率

3.60%

发文量

412

审稿时长

18 days

期刊介绍： The journal Ophthalmology, from the American Academy of Ophthalmology, contributes to society by publishing research in clinical and basic science related to vision.It upholds excellence through unbiased peer-review, fostering innovation, promoting discovery, and encouraging lifelong learning.