Foveal Müller Cell Cone as a Prognostic Optical Coherence Tomography Biomarker for Initial Response to Antivascular Endothelial Growth Factor Treatment in Cystoid Diabetic Macular Edema

Abstract

Purpose: To investigate the effect of the foveal Müller cell cone structure on the anatomical and functional response to intravitreal bevacizumab treatment in patients with diabetic macular edema. Methods: In 93 treatment-naive eyes with center-involved cystic type diabetic macular edema, spectral-domain optical coherence tomography scans of baseline were retrospectively evaluated to determine the foveal Müller cell cone structure and prognostic features including length of disorganization in the retinal inner layers and ellipsoid zone disruption. The area and circularity of the foveal avascular zone of the superficial and deep capillary plexus 1 month after intravitreal bevacizumab treatment were evaluated using optical coherence tomography angiography. Results: Destruction of the foveal Müller cell cone structure and a large foveal avascular zone in the deep capillary plexus (mm2) correlated strongly with a poor anatomical response (CST > 250 µm) at 1 month after first intravitreal bevacizumab (Exp [B] = 29.444, P = 0.002 and Exp [B] = 12.419, P = 0.013, respectively). A destroyed Müller cell cone structure (P = 0.008) and length of ellipsoid zone disruption (P < 0.001) at baseline were associated with poor visual acuity at 1 month after the first intravitreal bevacizumab. Conclusion: The foveal Müller cell cone structure correlates with the response to initial antivascular endothelial growth factor treatment.

Contribution of Müller Cells in the Diabetic Retinopathy Development: Focus on Oxidative Stress and Inflammation

“…DRIL is a good predictor of visual outcome [188]. Another correlation of MGC in DME has been related to the correlation of poor visual acuity and the destruction of Müller cell cones [189]. Altogether, these data indicate that MGC seem to be closely involved with DME.…”

Henle Fiber Layer Thickness and Area Measurement in Type 2 Diabetes Mellitus With and Without Retinopathy Using a Modified Directional Optical Coherence Tomography Strategy

“…The increased thickness of inner nuclear layer/outer plexiform layer complex was attributed to hypertrophy of Müller cell nuclei, which are located in the INL. 3,4 Henle fiber layer (HFL), composed of the axons of photoreceptors and the outer processes of the Z-shaped Müller cells, is located between the outer plexiform layer (OPL) and ONL in the macula. [4][5][6][7] Henle fiber layer appears hyporeflective and cannot be distinguished from ONL on an untilted OCT scan.…”

“…The increased thickness of inner nuclear layer/outer plexiform layer complex was attributed to hypertrophy of Müller cell nuclei, which are located in the INL. 3,4…”

“…3,4 Henle fiber layer (HFL), composed of the axons of photoreceptors and the outer processes of the Z-shaped Müller cells, is located between the outer plexiform layer (OPL) and ONL in the macula. [4][5][6][7] Henle fiber layer appears hyporeflective and cannot be distinguished from ONL on an untilted OCT scan. If the pupil entry position of the OCT beam is changed temporally or nasally and a tilted OCT scan is obtained (directional OCT), HFL appears hyperreflective at the contrary site and cannot be distinguished from OPL.…”

Correspondence

“…We read with great interest the recently published paper entitled “Foveal Müller cell cone as a prognostic optical coherence tomography biomarker for initial response to antivascular endothelial growth factor treatment in cystoid diabetic macular edema”. 1 In this study, Choi et al performed an interesting assessment of the impairment of foveal Müller cells in diabetic macular edema (DME), showing a relationship between the response to anti-VEGF injections and the morphofunctional outcome. The impairment of foveal Müller cells has been already postulated in our paper entitled “Foveal Eversion: A Possible Biomarker of Persistent Diabetic Macular Edema”.…”