背景 抗VEGF药物ranibizumab玻璃体腔注射治疗糖尿病黄斑水肿(DME)的相关研究均以治疗前后中心视网膜厚度(CRT)绝对改变(ACRT)进行分析,而对治疗后CRT相对于治疗前CRT(RCRT)或治疗前增厚的CRT减少程度(RCRTing)即相对变化量的研究较少.目的 探讨DME患者行ranibizumab玻璃体腔注射后RCRT、RCRTing在视力预后判断中的作用.方法 采用自身对照系列病例观察研究设计,于2013年11月至2014年10月在中国核工业北京四○一医院眼科确诊的30例30眼临床显著糖尿病黄斑水肿(CSDME)患者,所有患眼均用30 G注射针头于颞下方角膜缘后3.5 mm处进入玻璃体腔,注射10 mg/ml的ranibizumab注射液0.05 ml.分别于治疗前和治疗后3、6个月,利用ETDRs改良视力表测定2.5m处的最佳矫正视力(BCVA) (LogMAR),计算治疗前与治疗后6个月BCVA绝对变化值(ABCVA);采用SD-OCT检测系统测量CRT黄斑中心直径1.0 mm处的CRT,计算治疗后6个月患眼的RCRT、RCRTing值,分析RCRT、RCRTing与ABCVA间的关系.结果 CSDME患者治疗前及治疗后3、6个月BCVA分别为(0.66±0.20)、(0.40±0.25)、(0.37±0.25) LogMAR,治疗前后BCVA比较差异有统计学意义(F=36.79,P＜0.05),其中治疗后各时间点与治疗前比较视力明显改善,差异均有统计学意义(均P＜0.05),患眼的ABCVA为(0.30±0.21)LogMAR.治疗前、治疗后3、6个月CRT值分别为(508.63±130.44)、(331.07±71.84)和(311.77±64.47) μm,治疗前及治疗后不同时间点间CRT的总体比较差异有统计学意义(F=49.78,P＜0.05),治疗后各时间点患眼的CRT值较治疗前均明显下降,差异均有统计学意义(均P＜0.05),患眼ACRT值为(196.87±140.59) μm.RCRT＜35％组和RCRT≥35％组患者的ABCVA分别为(0.13±0.13)、(0.44±0.14) LogMAR;RCRTing＜69％组和RCRTing≥69％组患者ABCVA分别为(0.07±0.09)、(0.41±0.15) LogMAR,与RCRT＜35％组比较,RCRT≥35％组ABCVA(LogMAR)更好,CRT则下降显著,差异均有统计学意义(t=-6.27、-8.65,均P＜0.05).CSDME患者RCRT、RCRTing与ABCVA均呈明显正相关(r=0.86,0.79,均P＜0.05).结论 RCRT、RCRTing均能特征性反映DME患者接受ranibizumab治疗后视力及CRT变化,且与视力预后相关,RCRT较RCRTing与ABCVA相关程度强;对于CRT值较大的患者采用RCRTing分析或许是首选.%Background The studies on intravitreal ranibizumab for diabetic macular edema (DME) primarily focuses on the absolute change of central retinal thickness, while the affection of the relative change of central retinal thickness (RCRT) or relative change of central retinal thickening (RCRTing) on visual prognosis has not been elucidated completely.Objective This study aimed to evaluate the effect of RCRT and RCRTing in assessing visual prognosis in DME patients following intravitreal injection of ranibizumab.Methods A self-controlled observational study was designed.Thirty eyes of thirty patients with clinically significant DME (CSDME) were recruited in Beijing 401 Hospital of China Nuclear Industry from November 2013 to October 2014.Ranibizumab of 0.05 ml (10 mg/ml) was intravitreally injected by 30G syringe needle at 3.5 mm posterior corneal limbus.Best corrected visual acuity (BCVA) far 2.5 meters away modified ETDRs visual chart was examined before injection and 3 and 6 months after injection,and the BCVA difference value between before injection and 6 months after injection was calculated as the absolusion BCVA (ABCVA).Spectral domian optical coherence tomography (SD-OCT) system was employed to measure the central retinal thickness (CRT) and to calculate the RCRT and RCRTing value.The correlations of RCRT or RCRTing with ABCVA was analyzed.Results The LogMAR values were (0.66±0.20) ,(0.40±0.25) BCVA and (0.37±0.25) before injection and 3,6 months after injection respectively in the CSDME patients,with a significant difference among them (F =36.79,P＜0.05).The values were obviously improved 3 and 6 months after injection compared with before injection (both at P＜0.05).The mean ABCVA (LogMar) of the patients was (0.30±0.21).The CRT 3,6 ,pmyjd sgyrt omkrvyopm values were (508.63±130.44), (331.07±71.84) and (311.77±64.47)μm before injection and respectively in the CSDME patients, showing a significant difference among them (F=49.78,P＜0.05).The CRT values were evidently reduced 3 and 6 months after injection in comparison with before injection (both at P＜0.05) ,and the mean ACRT value was (196.87±140.59) μm.The ABCVA values were (0.13±0.13),(0.44±0.14),(0.07±0.09) and (0.41±0.15) LogMAR in the RCRT＜35％ group,RCRT≥ 35％ group,RCRTing＜69％ group and RCRTing ≥ 69％ group, respectively.Significant differences were found in ABCVA between the RCRT＜35％ group and RCRT≥35％ group (t=-6.27,-8.65,both at P＜0.05).RCRT and RCRTing showed the positive correlations with ABCVA in the CSDME patients (r =0.86,0.79, P ＜ 0.05).Conclusions RCRT and RCRTing can identify well the optimal responders to intravitreal ranibizumab and predict BCVA improvement after treatment.RCRT has better association with ABCVA than RCRTing.RCRTing may be preferable when retinal thickening is more severe.
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