The Analysis Of Baseline Characteristics Of Diabetic Macular Edema Of Different Types And The Efficacy Of Intravitreal Ranizumab

Objectives: Comparative analyzing the macular area morphology,microcirculation characteristics and the differences in morphology and microcirculation in the macular area before and after the treatment of intravitreal ranizumab(IVR)in different types of diabetic macular oedema(DME)based on optical coherence tomography(OCT).To look for possible pathogenic causes of different typed DME,to explore the effect of baseline characteristic differences on the short-term therapeutic effect of anti-vascular endothelial growth factor(VEGF).Methods: Non-randomized case-control study.In this study,the eyes were diagnosed with diabetic macular oedema(DME)and the macular foveal retinal thickness(CST)≥250μm proposed for anti-VEGF treatment in the ophthalmology department of our hospital from March 2021 to November 2022,were collected in the study.Basing on the OCT results the DME eyes were divided into: diffused retinal thickening(DRT)group,cystoid macular edema(CME)group,diffuse retinal thickening with serous retinal detachment(SRD)group.A total of 116 eyes were included in the study,33 eyes in the DRT group,46 eyes in the CME group and 37 eyes in the CME with SRD group;The following indexes were evaluated: best corrected visual acuity(BCVA),Diabetic retinopathy(DR),OCT indicators reflecting the morphological characteristics of the macular area and optical coherence tomography(OCTA)indicators reflecting the microcirculation characteristics of the macular area.Among them,104 affected eyes were treated with three consecutive intravitreal ranizzumab,28 eyes in DRT group,46 eyes in CME group and 30 eyes in CME with SRD group were reviewed one month after three consecutive IVR,and the eye examination data was recorded.Analyzing the differences in macular morphology,microcirculation characteristics at baseline and the efficacy of intravitreal ranizumab among the three groups.Results: 1.Comparison of general conditions: there were no significant differences in gender,age,duration of diabetes mellitus,blood glucose,creatinine value,total bilirubin value,platelet count(PLT)and platelet hematocrit pct(PCT)among the three groups(P> 0.05);The mean platelet volume(MPV)was significantly higher in the CME with SRD group than that in the DRT and CME groups,The proportion of CME with SRD in severe non-proliferative diabetic retinopathy(NPDR)and proliferative diabetic retinopathy(PDR)was significantly higher than that in the DRT and CME groups.The mean distribution width(PDW)of platelets in the DRT group was significantly lower than that in the CME and CME with SRD groups(P<0.05);2.BCVA comparison: BCVA in CME with SRD group was significantly lower than that in DRT and CME groups(P <0.05);3.Comparison of OCT indicators: the macular foveal retinal thickness(CST)was significantly different among the three groups(P <0.05);The proportion of outer plexiform layer(OPL)and outer membrane(ELM)deletions were higher in the CME with SRD group than that in the DRT and CME groups;The proportion of elliptical band(EZ)deletion in CME with SRD and CME groups was higher than that in DRT group(P <0.05);In the CME with SRD group,the number of inner high reflection points(HF),outer HF and total HF were higher than that in CME and DRT groups(P<0.001);4.Comparison of OCTA indicators: higher flow density in superficial capillary plexus(SCP)and deep capillary plexus(DCP)in DRT group than that in CME and CME with SRD groups(P <0.05);The circumference of the foveal avascular zone(FAZ)in the CME group was longer than that in the DRT group(P <0.05);There were no significant differences in FAZ area,foveal avascular index AI,macular foveal vessel density FD-300 among the three groups(P> 0.05);5.Correlation analysis of HF quantity and OCT classification with platelet parameters and eye examination data:The number of HF was significantly positively associated with MPV,DR stage,OPL,ELM and EZ loss(P <0.05);OCT type was positively associated with DR stage,Log MAR BCVA,CST,ELM loss,total HF number,FAZ circumference,FAZ area,and negatively associated with SCP flow density(P <0.05);6.Comparison of BCVA,OCT and OCTA results between before and after treatment in the same group: Log MAR BCVA in CME with SRD group significantly improved compared with before treatment(P <0.05);CST decreased in DRT and CME with SRD groups(P <0.05);In CME and CME with SRD groups,the number of inner HF and outer HF were significantly reduced compared with those before treatment(P <0.05);SCP flow density and DCP flow density decreased in DRT group compared with before treatment(P <0.05),There were no significant differences in FAZ circumference,FAZ area,foveal avascular index AI,macular foveal vessel density FD-300 treatment(P> 0.05);7.Comparison of BCVA,OCT and OCTA results between before and after treatment among the three groups: BCVA and CST in CME with SRD group improved better than DRT and CME groups(P <0.05);change in outer HF number in CME with SRD group was more significant compared with DRT and CME groups(P<0.05);There were no significant differences in DCP flow density,FAZ circumference,FAZ area,foveal avascular perfusion zone AI,macular foveal vessel density FD-300(P <0.05).Conclusions: Compared to the DRT and CME groups,the proportion of CME with SRD group was higher in the severe NPDR and PDR at baseline;Initial BCVA was even worse,higher proportion of EZ,ELM deletions,more numbers of retinal HF,higher destruction of the retinal microcirculation in CME with SRD group;After the treatment of IVR,the visual and anatomical functions of the different typed DME eyes improved,however,only the CME with SRD group improved significantly;Namely,the appearance of SRD marking the progression of DME;However,the short-term effect of anti-VEGF treatment was obvious,which can be used as a predictive marker of response to DME treatment.MPV is an important factor leading to the formation of HF,HF number at baseline was significantly correlated with retinal tissue integrity,changes in HF number were significantly correlated with improvement in visual acuity with DME treatment,and HF can be used as an inflammatory marker in DME and predicted treatment response.