Clinical Research Among Patients With Center-Involved Diabetic Macular Edema And Good Central Visual Acuity

Part I Clinical Observation of Different Treatments Among Patients with Center-Involved Diabetic Macular Edema and Good Central Visual AcuityPurpose To describe the clinical observation of different treatments among patients with center-involved diabetic macular edema(CI-DME)and good central visual acuity in a real world setting.Methods A retrospective case control study including a total of 50 patients(65 eyes)selected in our hospital from January 2018 to May 2019,with CI-DME and best-corrected visual acuity(BCVA)?0.2 Log MAR.The eyes were incorporated into the treatment group(35 eyes of 27 patients)and observation group(30 eyes of 29patients)in terms of receiving intravitreal conbercept(IVC)or not.Change in BCVA,central subfield thickness(CST)and cube volume(CV)of the two groups were compared at the end of the follow-up.Also,the occurrence of epiretinal membrane(ERM),vitreous hemorrhage(VH)and pars plana vitrectomy(PPV)was observed in the two groups.Results(1)At baseline,there were no statistically significant differences in age,gender,laterality,duration of diabetes,insulin usage,nephropathy,diabetic retinopathy(DR)status,pseudophakic,intraocular pressure,BCVA,CST and CV between the two groups(P>0.05).(2)Change of BCVA in Log MAR:At the last follow-up,visual acuity of the treatment group(0.17±0.18)was superior than that of the observation group(0.27±0.24),but the difference was not statistically significant(t=-1.890,P=0.064).There was no significant difference in visual acuity between last follow-up(0.17±0.18)and baseline(0.13±0.08)in the treatment group(t=-1.402,P=0.170).Visual acuity at the last follow-up(0.27±0.24)was significantly lower than that at the baseline(0.14±0.07)in the observation group,the difference was statistically significant(t=-2.869,P=0.008).(3)Change of CST:At the last follow-up,CST of the treatment group was thinner than that of the observation group(355.7±77.7 vs 376.7±100.9)?m,but the difference was not statistically significant(Z=-0.772,P=0.440).There was a slightly reduction in CST(355.7±77.7)?m in the treatment group compared with its baseline(366.4±70.8)?m at the last follow-up,but this was not statistically significant(Z=-0.795,P=0.427).While CST(376.7±100.9)?m in the observation group was thicker than its baseline CST(345.1±48.3)?m,which was either no statistically significant difference(Z=-1.211,P=0.226).(4)Change of CV:At the last follow-up,there was no significant difference in CV(12.3±1.2 vs 12.4±1.3)mm~3between the treatment group and the observation group(t=-0.344,P=0.732).At the last follow-up,CV(12.3±1.2)mm~3in the treatment group decreased than that at baseline(12.9±1.5mm~3),the difference was statistically significant(t=2.288,P=0.029),while in the observation group,there was no statistically significant difference(t=-0.566,P=0.576)of CV between last follow-up(12.4±1.3)mm~3and baseline(12.3±1.3)mm~3.(5)During the follow-up,ERM and VH were each reported in 2 eyes(5.7%)and 2 eyes(5.7%)in the treatment group,while ERM and VH were each reported in 6 eyes(20%)and 5 eyes(16.7%)in the observation group,but the difference between the two groups was not statistically significant(P=0.130,P=0.234).Conclusions At the last follow-up,CI-DME patients with good central visual acuity who received IVC treatment were able to maintain good vision,while without receiving anti-VEGF treatment,those patients'visual acuity had significantly decreased compared with baseline.For those CI-DME patients with good central visual acuity,a close follow-up is badly needed and when there is a decrease in visual acuity,receiving a prompt anti-VEGF treatment is essential to maintain good vision.Part II Analysis of Risk Factors Resluting in Vision Loss in CI-DME Patients with Good Central Visual AcuityPurpose To explore the systemic and ocular risk factors resulting in vision loss in center-involved diabetic macular edema(CI-DME)patients with good central visual acuity.Methods A retrospective case control study including a total of 48 patients(63 eyes)selected in our hospital from January 2018 to May 2019,with CI-DME and best-corrected visual acuity(BCVA)? 0.2 Log MAR.The patients themselves chose to accept intravitreal conbercept(IVC)or only observation.At the last follow-up,the patients whose visual acuity remained or increased were included in the visial unimpaired group,and those whose visual acuity decreased ? 1 line were included in the visual impaired group.There were 35 eyes in 27 patients in the visial unimpaired group and 28 eyes in 24 patients in the visual impaired group.We aim to evaluate the correlation between vision loss and factors including age,gender,laterality,insulin usage,duration of diabetes,hypertension,nephropathy,baseline BCVA,diabetic retinopathy(DR)status,pseudophakic,retinal laser,DME shape,baseline central subfield thickness(CST),baseline macular cube volume(CV)and whether accepting IVC treatment or not in the two groups.Results Univariate analysis showed age and insulin usage were correlated with vision loss in CI-DME patients(P<0.05).Gender,laterality,duration of diabetes,hypertension,nephropathy,baseline BCVA,DR stage,pseudophakic,retinal laser,DME shape,baseline CST,baseline CV and whether accepting IVC treatment or not were not significantly correlated with vision loss in CI-DME patients(P>0.05).Multivariate logistic regression analysis showed that age(OR=1.120,95%CI1.027~1.221)and insulin usage(OR=6.278,95%CI1.183~33.312)were independent risk factors for vision loss in CI-DME patients(P< 0.05).Conclusion Age and insulin use were independent risk factors for vision loss in CI-DME patients with good central visual acuity,but no ocular risk factors were found associated with vision prognosis.