切换到地塞米松植入治疗糖尿病黄斑水肿的风险生物标志物在真实临床实践:一项多中心研究

IF 3.7 2区 医学 Q1 OPHTHALMOLOGY
Jorge Ruiz-Medrano, Patricia Udaondo Mirete, Marina Fernández-Jiménez, Monica Asencio-Duran, José Ignacio Fernández-Vigo, Marta Medina-Baena, Ignacio Flores-Moreno, Jesus Pareja-Esteban, Sara Touhami, Audrey Giocanti-Aurégan, Maria Vittoria Cicinelli, Anat Loewenstein, José M Ruiz-Moreno
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Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group. Results 275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. 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引用次数: 0

摘要

目的探讨基线治疗时不同光学相干断层扫描(OCT)生物标志物对抗血管内皮生长因子(VEGF)治疗糖尿病黄斑水肿(DME)潜在反应的影响。方法采用多中心、回顾性、病例系列研究的方法,对在实际临床中抗vegf后转而使用地塞米松植入物注射(dexamethasone implant注射剂,DEX-i)的DME患者进行研究。基线OCT图像上分析的生物标志物包括视网膜内液(IRF)、视网膜下液(SRF)、视网膜内层紊乱(DRIL)、视网膜外层紊乱(DROL)、高反射灶(HRF)、高反射囊样壁(HCW)、密集的视网膜内囊肿(DIR)和玻璃体黄斑界面(VMI)异常。二甲醚是根据欧洲眼科高级研究学院的分类进行分类的。接受抗vegf注射治疗且反应良好的患者作为对照组。结果本研究共分析了275只眼;209只眼(76.0%)从抗vegf转换为DEX-i,对照组66只眼(24.0%)。需要转换的患者年龄较大,初始BCVA较差,CRT较高。Logistic回归分析显示,女性性别、年龄、中央视网膜厚度、糖尿病类型、SRF、HCW、DIR和VMI增加了转换的可能性。其中两个因素(SRF, HCW, VMI)的存在所产生的需要切换的OR为48.95。三个都有乘以4.56×1016。如果基线OCT在基线时显示SRF、HCW和VMI生物标志物中的两项,则抗vegf治疗失败的风险接近50%。在所有三种生物标志物的基线存在下,抗vegf治疗的失败几乎是肯定的。如有合理要求,可提供资料。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Biomarkers of risk of switching to dexamethasone implant for the treatment of diabetic macular oedema in real clinical practice: a multicentric study
Objective To establish the influence of different optical coherence tomography (OCT) biomarkers at baseline treatment on the potential response to anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME). Methods Multicentric, retrospective, case-series study in patients with DME switched to dexamethasone implant injections (DEX-i) after anti-VEGF in real clinical practice. Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group. Results 275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. The OR regarding the need to switch generated by the presence of two of these three factors (SRF, HCW, VMI) was 48.95. Having all three multiplies it by 4.56×1016. Conclusion If baseline OCT shows two of SRF, HCW and VMI biomarkers at baseline, the risk of failure of anti-VEGF therapy is close to 50%. In the presence at baseline of all three biomarkers, failure of anti-VEGF therapy is almost certain. Data are available upon reasonable request.
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来源期刊
CiteScore
10.30
自引率
2.40%
发文量
213
审稿时长
3-6 weeks
期刊介绍: The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.
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