Observation And Analysis Of The Efficacy Of Conbercept In The Treatment Of Diabetic Macular Edema Based On Optical Coherence Tomography And Optical Coherence Tomography Angiography

Objective: To investigate the influencing factors of optical coherence tomography and optical coherence tomography angiography（OCT and OCTA）characteristics at baseline on the improvement of best-corrected visual acuity（BCVA）and reduction of central macular thickness（CMT）after anti-vascular endothelial growth factor（VEGF）therapy in diabetic macular edema（DME）patients.Methods: Retrospective study.A total of 72 patients（72 eyes）with DME who were treated by the Department of Ophthalmology of the First Affiliated Hospital of Bengbu Medical College from October 2020 to September 2021 were included,including 41 males and 31 females.The age ranged from 35 to77（56.53±7.85）years.General data such as gender,age,presence or absence of hypertension,diabetes course,diabetic retinopathy（DR）course,glycosylated hemoglobin,and DR stage were collected.All patients were treated with intravitreal injection of conbercept,and the treatment plan was 3+PRN.The BCVA and CMT before and after treatment were compared for grouping,and the efficacy was evaluated.After 3 months of treatment,BCVA increased ≥0.2,38 cases（38 eyes）in the good visual acuity improvement group,and 34 cases（34 eyes）in the poor improvement group;CMT decreased ≥20%,47 cases（47eyes）in the good edema regression group,on the contrary,25 cases（25 eyes）were in the poor group.The BCVA,CMT,external limiting membrane（ELM）and ellipsoid zone（EZ）integrity,serous retinal detachment（SRD）,vascular density in superficial capillary plexuses（SCP）,vascular density in deep capillary plexuses（DCP）,the area of foveal avascular zone（FAZ）were measured by OCT/OCTA at baseline and 3 months after treatment in the two groups respectively.Univariate and multivariate analyses were performed to identify independent predictors of short-term BCVA improvement and CMT reduction after anti-VEGF therapy.Results: 1.There were no statistically significant differences in gender,age,presence or absence of hypertension,duration of diabetes,duration of DR,glycosylated hemoglobin,DR stage and other general conditions between good vision improvement group and poor vision improvement group（all P>0.05）.There was no statistical difference between the good edema regression group and the bad edema regression group（all P>0.05）.2.The interruption rate of ELM and EZ and proportion of SRD at baseline in the poor vision improvement group were higher than those in the good group,and the differences were statistically significant（all P<0.05）;There were no significant differences in baseline BCVA,baseline CMT,SCP vessel density,DCP vessel density and FAZ area between the two groups（all P>0.05）.Further multivariate logistic regression analysis showed that baseline ELM and EZ integrity were independent factors influencing BCVA improvement after treatment.3.The baseline CMT,proportion of SRD and baseline DCP vascular density in the good edema regression group were higher than those in the poor group,and the differences were statistically significant（all P<0.05）.There were no significant differences in baseline BCVA,baseline ELM and EZ integrity,baseline SCP vascular density,and baseline FAZ area between the two groups（all P>0.05）.Further multivariate logistic regression analysis showed that baseline CMT,baseline SRD,and baseline DCP vascular density were independent influencing factors of CMT reduction after treatment.4.There were statistically significant differences in BCVA and CMT before and after treatment between good vision improvement group and poor group,good edema regression group and poor group（all P<0.05）;After treatment,the proportion of SRD in good vision improvement group,poor vision improvement group and good edema regression group decreased（all P <0.05）,but there was no significant change in the proportion of SRD in the poor edema regression group;There were no significant differences in integrity of ELM and EZ,proportion of SRD,SCP vascular density,DCP vascular density and FAZ area before and after treatment（all P>0.05）.Conclusions: 1.Disruption of ELM and EZ on OCT at baseline predicted worse functional response（BCVA）in DME patients after anti-VEGF therapy.The integrity of ELM and EZ at baseline may be influencing factors for short-term functional response to anti-VEGF therapy in DME patients.2.The higher the baseline CMT,the presence of SRD at baseline,and the higher the baseline DCP vascular density,the better the anatomical response（CMT）after anti-VEGF treatment.Baseline CMT,baseline SRD,and baseline DCP vascular density may be influencing factors of short-term anatomical response to anti-VEGF therapy in DME patients.