The Effects of Anti-Vascular Endothelial Growth Factor Loading Injections on Retinal Microvasculature in Diabetic Macular Edema.

IF 2.6 3区医学 Q2 OPHTHALMOLOGY Translational Vision Science & Technology Pub Date : 2024-12-02 DOI:10.1167/tvst.13.12.37

Kiyoung Kim, Junwoo Lee, Seung-Young Yu

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Abstract

Purpose: To evaluate changes in the retinal microvasculature using widefield swept-source optical coherence tomography angiography (SS-OCTA) following three anti-vascular endothelial growth factor (anti-VEGF) loading injections for diabetic macular edema (DME).

Methods: Thirty-four treatment-naïve patients with DME received an initial three loading injections, followed by injections on an as-needed basis. Macular ischemia was evaluated based on the foveal avascular zone (FAZ) area, perfusion density, and vessel density on a 3 × 3-mm SS-OCTA image. Midperipheral ischemia was analyzed by dividing a 12 × 12-mm image into 16 boxes to compare changes in the nonperfusion area (NPA). Participants were categorized as aggravated, stable, or improved based on changes in the NPA after three injections.

Results: Of the 34 included patients, eight (23.5%) demonstrated aggravation of the NPA, 23 (67.6%) remained stable, and three (8.8%) exhibited improvement. Although FAZ area, perfusion, and vessel density increased, the differences were not significant compared to baseline. The number of injections and glycated hemoglobin (HbA1c) levels in the NPA aggravation group were significantly higher than in the stable and improvement groups. Logistic regression analysis revealed that NPA aggravation was independently associated with the number of anti-VEGF injections.

Conclusions: Changes in NPA following anti-VEGF loading injections varied among patients with DME and were significantly associated with HbA1c levels and injection frequency. Worsening mid-peripheral NPA after the anti-VEGF injections independently risked DME recurrence.

Translational relevance: We revealed that worsening mid-peripheral retinal ischemia after anti-VEGF loading injections contributes to the recurrence of DME.

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抗血管内皮生长因子负载注射对糖尿病黄斑水肿视网膜微血管的影响。

目的：利用宽视场扫描源光学相干断层扫描血管造影（SS-OCTA）评估三次抗血管内皮生长因子（anti-VEGF）加载注射治疗糖尿病黄斑水肿（DME）后视网膜微血管的变化。方法：34例treatment-naïve二甲醚患者最初接受三次负荷注射，随后根据需要进行注射。根据3 × 3 mm SS-OCTA图像上的中央凹无血管区（FAZ）面积、灌注密度和血管密度评估黄斑缺血。采用12 × 12 mm图像分成16个方框，比较非灌注区（NPA）的变化。根据三次注射后NPA的变化，参与者被分为加重、稳定或改善。结果：34例患者中，8例（23.5%）表现为NPA加重，23例（67.6%）表现为稳定，3例（8.8%）表现为改善。虽然FAZ面积、灌注和血管密度增加，但与基线相比差异不显著。NPA加重组的注射次数和糖化血红蛋白（HbA1c）水平明显高于稳定组和改善组。Logistic回归分析显示NPA加重与抗vegf注射次数独立相关。结论：抗vegf负荷注射后NPA的变化在DME患者中有所不同，且与HbA1c水平和注射频率显著相关。抗vegf注射后中外周NPA恶化是DME复发的独立风险。翻译相关性：我们发现抗vegf加载注射后中周视网膜缺血恶化有助于DME的复发。

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

Translational Vision Science & Technology Engineering-Biomedical Engineering

CiteScore

5.70

自引率

3.30%

发文量

346

审稿时长

25 weeks

期刊介绍： Translational Vision Science & Technology (TVST), an official journal of the Association for Research in Vision and Ophthalmology (ARVO), an international organization whose purpose is to advance research worldwide into understanding the visual system and preventing, treating and curing its disorders, is an online, open access, peer-reviewed journal emphasizing multidisciplinary research that bridges the gap between basic research and clinical care. A highly qualified and diverse group of Associate Editors and Editorial Board Members is led by Editor-in-Chief Marco Zarbin, MD, PhD, FARVO. The journal covers a broad spectrum of work, including but not limited to: Applications of stem cell technology for regenerative medicine, Development of new animal models of human diseases, Tissue bioengineering, Chemical engineering to improve virus-based gene delivery, Nanotechnology for drug delivery, Design and synthesis of artificial extracellular matrices, Development of a true microsurgical operating environment, Refining data analysis algorithms to improve in vivo imaging technology, Results of Phase 1 clinical trials, Reverse translational ("bedside to bench") research. TVST seeks manuscripts from scientists and clinicians with diverse backgrounds ranging from basic chemistry to ophthalmic surgery that will advance or change the way we understand and/or treat vision-threatening diseases. TVST encourages the use of color, multimedia, hyperlinks, program code and other digital enhancements.