Foveal Microvascular Integrity Association With Anti-VEGF Treatment Response for Diabetic Macular Edema

Abstract

To investigate the association between foveal microvascular integrity and antivascular endothelial growth factor (VEGF) treatment response for diabetic macular edema (DME).METHODS. This retrospective study enrolled 58 eyes (from 45 patients) with DME. Treatment strategy was three to five monthly anti-VEGF injections followed by a PRN protocol. Treatment with an intravitreal corticosteroid would be considered for persistent DME after five consecutive anti-VEGF injections. Eyes achieving a treatment-free interval ≥ four months within two years were classified into the good clinical course group (group 1). Eyes with frequent recurrent edema (treatment-free interval < four months) or requiring an intravitreal corticosteroid within two years were classified into the suboptimal clinical course group (group 2). Foveal microvascular integrity was evaluated by two continuous variables, that is, vessel density (%) within a width of 300 μm around the foveal avascular zone (FD-300) on optical coherence tomography angiography (OCTA) and perifoveal leakage (area %) on fluorescein angiography (FA). RESULTS.There were 37 eyes in group 1 and 21 eyes in group 2. FD-300 (odds ratio 0.733, 95% CI 0.620-0.867, P < 0.001) and perifoveal leakage (odds ratio 1.064, 95% CI 1.007-1.124, P = 0.027) were significantly associated with suboptimal clinical course. Area under curve (AUC) was 0.820 for FD-300 and 0.723 for perifoveal leakage in predicting clinical course. FD-300 was negatively correlated with perifoveal leakage (coefficient = −0.325, P = 0.014). CONCLUSIONS.Compromised foveal microvascular integrity, represented by lower FD-300 and more severe perifoveal fluorescein leakage, was associated with suboptimal clinical course in anti-VEGF treatment for DME. A negative correlation between FD-300 and perifoveal leakage existed.

One Year Results of Faricimab for Aflibercept-Resistant Diabetic Macular Edema

“…Studies have reported an assortment of treatment schedules prior to considering a subject to be with recalcitrant DME, including three consecutive monthly anti-VEGF treatments, 8 four successive anti-VEGF injections, 9 or a minimum of six consecutive anti-VEGF treatments. 10 However, a subset of patients with DME may need 6–12 months of continuous treatment in order to resolve the fluid on OCT 11 so the author only included patients in this study who had undergone at least eight aflibercept injections over 12 months to make sure the patient with DME was truly recalcitrant to aflibercept treatment. Recurring anti-VEGF treatments over long time periods may produce immunoreactivity and tachyphylaxis with reduced therapeutic effect, 12 and changing to another anti-VEGF medication may sometimes overcome this issue.…”

Treatment of Intravitreal Ranibizumab Resistant Radiation Retinopathy with Intravitreal Dexamethasone Implant: A Case Report

“…Although the response to anti-VEGF therapy is reported to be good, persistent or resistant macular edema may also be seen ( 7 - 9 ). In addition, control of macular edema and retinal structure with OCT is recommended after 3 to 5 intravitreal anti-VEGF loading doses in diabetic macular edema ( 10 , 11 ). Although three loading doses are generally valid in Türkiye, there may be differences between the opinion of physicians and clinics.…”