Effect of Anti–Vascular Endothelial Growth Factor Therapy on Choroidal Thickness in Diabetic Macular Edema

Yiu, Glenn; Manjunath, Varsha; Chiu, Stephanie J.; Farsiu, Sina; Mahmoud, Tamer H.

doi:10.1016/j.ajo.2014.06.006

Cited by 100 publications

(91 citation statements)

References 28 publications

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“…5 ). When monitoring anti-VEGF therapy responses, the thickness of the ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), and choroidal layer may decrease; a correlation with vision loss could only be shown for the GCL, whereas a decrease in choroidal thickness during therapy does not correlate with less vision gain [40][41][42] . On the other hand, a thick subfoveal choroid at baseline may predict good vision outcomes [43] .…”

Section: Evidencementioning

confidence: 99%

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

García-Arumí²,

et al. 2017

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Diabetic retinal disease is envisioned to become the plague of the coming decades with a steep increase of worldwide diabetes incidence followed by a substantial rise in retinal disease. Improvements in diagnostic and therapeutic care have to cope with this dilemma in a clinically and socioeconomically efficient manner. Laser treatment has found a less destructive competitor in pharmacological treatments. As a consequence of recent rigorous clinical trials, laser photocoagulation is no longer recommended for the treatment of diabetic macular edema (DME), and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids have maintained a role in the management of chronically persistent DME. The paradigm shifts in therapy are accompanied by a substantial break-through in diagnostics. The following guidance for the management of DME has been composed from the best updated knowledge of leading experts in Europe and represents another volume in the series of EURETINA recommendations for the management of retinal disease.

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Section: Evidencementioning

confidence: 99%

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

García-Arumí²,

et al. 2017

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“…Anti-VEGF treatment has demonstrated utility in improving visual and anatomical outcomes in DME (4)(5)(6)(7)(8)(9)(10) . The effects of anti-VEGF therapy on choroidal thickness in various diseases, including AMD and DM, have been reported in several previous studies (18,19) . Yiu et al demonstrated that central choroidal thickness decreases following anti-VEGF therapy for DME after 6 months (19) .…”

Section: Discussionmentioning

confidence: 73%

“…The effects of anti-VEGF therapy on choroidal thickness in various diseases, including AMD and DM, have been reported in several previous studies (18,19) . Yiu et al demonstrated that central choroidal thickness decreases following anti-VEGF therapy for DME after 6 months (19) . The present study also found a statistically significant decrease in choroidal thickness among patients following anti-VEGF injections.…”

Section: Discussionmentioning

confidence: 73%

“…Currently, intravitreal anti-VEGF injections are the most common treatment for DME. Though anti-VEGF injections improved visual acuity, several studies demonstrated an association with decreased central retinal thickness (18,19) . However, there is currently a lack of studies investigating the effect of anti-VEGF injections on the choroid in patients with diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT

Kniggendorf¹,

Novais²,

Kniggendorf³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Approved by the following research ethics committee: UNIFESP (#1.093.853). ABSTRACTPurpose: To evaluate choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT) imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). Methods: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab) in a pro re nata (PRN) regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits. Results: Thirty-nine eyes (15 females, 24 males) from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years). Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5). Mean nasal, subfoveal, and temporal choroidal thickness (CT) measurements at baseline were 234.10 ± 8.63 μm, 246.89 ± 8.94 μm, and 238.12 ± 8.20 μm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 μm, 215.66 ± 8.29 μm, and 212.43 ± 8.14 μm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327). Conclusions: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.

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“…26 Therefore, blocking the action of VEGF on the choroid with anti-VEGF therapy, the permeability of the choroidal vasculature decreases, which can be noted by a decrease in CT. Lains et al 3 demonstrated a significant decrease in CT in DME patients following treatment with anti-VEGF therapy. In a more recent study by Yiu et al, 27 CT was also found to decrease significantly in patients receiving anti-VEGF therapy. In this study we included patients without prior anti-VEGF treatment to overcome this limitation.…”

Section: Discussionmentioning

confidence: 81%

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular edema

Totan

Akyüz

Güler

et al. 2015

Eye

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Purpose The aim of this study is to evaluate the ocular pulse amplitude (OPA) and choroidal thickness (CT) measurements in patients with diabetic macular edema (DME) and healthy subjects. Methods A total of 34 patients (12 male and 22 female) who had type 2 diabetes mellitus with DME and 34 sex-matched healthy subjects (13 male and 21 female) were included in this prospective study. The intraocular pressure (IOP) and OPA were measured with Dynamic contour tonometer (Pascal DCT, Switzerland). The subfoveal CT was measured using the Cirrus HD-OCT (Carl Zeiss Meditec). The CT at 1500 μm and 3000 μm nasal and temporal to the central fovea was also measured. Results The mean IOP values were 18.4 ± 3.5 and 17.1 ± 2.1 mm Hg in DME patients and healthy controls, respectively (P = 0.091). The mean OPA values in patients with DME (2.58 ± 0.96) and controls (3.52 ± 1.03) were statistically different (Po0.001). The mean subfoveal CT value was 273.5 ± 30.2 μm in the eyes with DME and 321.4 ± 36.5 μm in the control group (Po 0.001). In both groups, linear regression analysis showed no significant association between OPA and CT measurements. The IOP showed a significantly positive correlation with OPA in both DME (P = 0.002, r = 0.526) and controls (P = 0.004, r = 0.483). Conclusions The current study suggests that both pulsatile choroidal blood flow and CT are decreased in patients with DME.

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Effect of Anti–Vascular Endothelial Growth Factor Therapy on Choroidal Thickness in Diabetic Macular Edema

Cited by 100 publications

References 28 publications

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular edema

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