Predictive value of the characteristics of intraretinal cystoid spaces on early response to antivascular endothelial growth factor treatment in patients with cystoid diabetic macular edema

ABSTRACT Purpose: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. Methods: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. Results: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). Conclusion: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.

摘要 目的：评估接受玻璃体内抗血管内皮生长因子（intravitreal antivascular endothelial growth factor, anti-VEGF）注射治疗（贝伐珠单抗（bevacizumab）1.25mg/0.05ml）的糖尿病性囊样黄斑水肿（diabetic cystoid macular edema, DCME）患者，其基线光谱域光学相干断层扫描（spectral-domain optical coherence tomography, SD-OCT）下的视网膜内囊样间隙（intraretinal cystoid spaces）特征是否可预测患者的视力预后。方法：本研究纳入因囊样黄斑水肿接受连续3次玻璃体内贝伐珠单抗注射的患者，探讨注射前囊样间隙的各项特征与注射后解剖学、功能性结局的关联。评估指标包括判定功能性成功的最佳矫正视力（best-corrected visual acuity, BCVA），以及判定解剖学成功的中心亚区厚度（central subfield thickness, CST）。同时分析囊样间隙的位置与感光细胞层及视网膜内层完整性的相关性。结果：本研究共纳入36例患者的36只眼，注射后患者的平均最佳矫正视力显著提升（p=0.002），平均中心亚区厚度显著降低（p=0.003）。伴外核层（outer nuclear layer）囊样间隙的患眼，其最佳矫正视力提升幅度受限（p=0.045）。视力预后不佳的患眼，其囊腔内反射强度高于视力预后良好的患眼（p=0.028）。22例伴外核层囊样间隙的患眼中，有13例（59.0%）存在椭圆体带（ellipsoid zone）中断；而14例未伴外核层囊样间隙的患眼中，仅1例（7.1%）出现椭圆体带中断，组间差异具有统计学意义（p=0.009）。伴外核层囊样间隙的患眼中，有15例（68.1%）存在视网膜内层（retinal inner layers）结构紊乱；而未伴外核层囊样间隙的患眼中仅2例（14.2%）出现该表现，组间差异具有统计学意义（p=0.013）。结论：视网膜内囊样间隙的特征可预测糖尿病性囊样黄斑水肿患者的预后，伴外核层囊样间隙的患眼，其视力获益可能受限。