Abstract：
The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.74 ± 5.44. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR - 0.38, 95% CI - 6.97 ~ - 1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.
摘要：
本回顾性介入病例系列的目的是比较根据台湾国家保险局报销政策，玻璃体内使用阿柏西普或雷珠单抗治疗的糖尿病性黄斑水肿（DME）和增生性糖尿病性视网膜病变（PDR）的功能和解剖结果。收集84只眼，所有眼睛都用光谱域光学相干断层扫描（SD-OCT）成像，彩色眼底照片（CFP），和荧光素血管造影(FA)。治疗开始后24个月，logMARBCVA从0.58±0.33提高到0.47±0.38(p<0.01)，CRT从423.92±135.84下降到316.36±90.02（p<0.01），微动脉瘤的数量从142.14±57.23减少到75.32±43.86（p<0.01）。平均注射计数为11.74±5.44。logMARBCVA没有组间差异（p=0.96），CRT（p=0.69），或注射计数（p=0.81）。然而,在随访结束时用阿柏西普治疗的眼中，微动脉瘤的平均数量略有减少（p=0.06），补充全视网膜光凝（PRP）（p=0.04）和亚阈值微脉冲激光（SMPL）治疗（p=0.01）的发生率也降低。多因素分析显示，只有初始logMARBCVA影响最终的VA改善（比值比（OR）0.49，95％置信区间（CI）0.21〜0.93，p<0.01）；相反，年龄（OR-0.38，95％CI-6.97〜-1.85，p<0.01）和初始CRT（OR0.56，95％CI0.34〜0.84，p<0.01）都影响了24个月时最终的CRT减少。总而言之,就VA而言，阿柏西普和雷珠单抗在PDR治疗DME方面均有效，CRT和MA计数。与接受雷珠单抗相比，接受阿柏西普治疗的眼睛需要更少的补充PRP和SMPL治疗。最初的VA影响了24个月时的最终VA改善，而年龄和初次CRT是24个月CRT减少的预后预测因子.
