Indicators of Visual Prognosis in Diabetic Macular Oedema

Sen, Sagnik; Ramasamy, Kim; Sivaprasad, Sobha

doi:10.3390/jpm11060449

Cited by 16 publications

(7 citation statements)

References 119 publications

(134 reference statements)

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“…Therefore, it is necessary to study further the relationship between the detailed characteristics of imaging and the prognosis. Many DME-related biomarkers based on SD-OCT imaging, such as CST, choroidal thickness, HRD, HE, SRF, IRC, EZ or ELM rupture, and DRIL, have been proven to be general prognostic biomarkers of anatomical or functional outcomes [13][14][15][16][17]. In the future, the information parameters of macular perfusion provided by OCTA will be further used in the evaluation system [18].…”

Section: Discussionmentioning

confidence: 99%

Predictive effect of TCED-HFV grading and imaging biomarkers on anti-VEGF therapy in diabetic macular edema

Lei

Hao

Cheng

et al. 2023

Preprint

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Background To evaluate the predictive effect of TCED-HFV grading and imaging biomarkers on anti-vascular endothelial growth factor (anti-VEGF) treatment in diabetic macular edema (DME). Methods 81 eyes of 81 DME patients who were treated with anti-VEGF were included in this retrospective cohort study. All patients underwent a comprehensive ophthalmic examination at baseline and follow-up, including best-corrected visual acuity (BCVA), fundus photography, and spectral domain–optical coherence tomography (SD-OCT). Baseline imaging biomarkers were qualitatively and quantitatively graded according to the TCED-HFV classification protocol, and DME was divided into early stage, advanced stage, severe stage, and atrophy stage. Results Six months post treatment, central subfield thickness (CST) in 49 eyes (60.5%) had decreased by 10% from baseline, 30 eyes (37.0%) had achieved CST < 300 µm, and 45 eyes (55.6%) had BCVA improved by more than five letters. Multivariate regression analysis revealed that eyes with baseline CST ≥ 390 µm had a higher probability of ≥ 10% reduction in CST from baseline, and eyes with abundant hyperreflective dots (HRD) had a lower probability of 10% reduction in CST (all P < 0.05). Eyes with vitreomacular traction (VMT) or epiretinal membrane (ERM) at baseline were less likely to reach the end point of CST < 300 µm (P < 0.05). BCVA increases of more than five letters were less likely in eyes with baseline BCVA ≥ 69 letters, complete or partial destruction of ellipsoid zone (EZ) at baseline (all P < 0.05). TCED-HFV staging was negatively correlated with BCVA at both baseline and 6 months (Kendall’s tau-b=-0.39 and − 0.55, all P < 0.01). TCED-HFV staging was positively correlated with CST at 6 months (Kendall’s tau-b = 0.19, P = 0.049) and negatively correlated with the reduction of CST (Kendall’s tau-b=-0.32, P < 0.01). Conclusion The TCED-HFV grading protocol facilitates a comprehensive assessment of DME severity, standardizes the grading of multiple imaging biomarkers, and predicts the anatomical and functional outcomes of anti-VEGF treatment.

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Section: Discussionmentioning

confidence: 99%

Predictive effect of TCED-HFV grading and imaging biomarkers on anti-VEGF therapy in diabetic macular edema

Lei

Hao

Cheng

et al. 2023

Preprint

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“…A normal choroidal function is necessary for metabolic support of the outer retina (28). Studies on SFCT in eyes with DME have yielded inconsistent results (29). However, regarding the role of the choroid in the pathophysiology of DME, it is suggested that decreased subfoveal choroidal circulation in people with retinopathy secondary to type 2 DM (especially in eyes with DME) could lead to relative hypoxia in the outer retina and retinal pigment epithelial (RPE), which, in turn, could result in increased permeability of the outer blood-retinal barrier and drainage dysfunction of RPE (2).…”

Section: Discussionmentioning

confidence: 99%

Changes in central retinal and choroidal OCT/OCTA parameters following intravitreal bevacizumab injection in diabetic macular edema

Firouzabadi,

Farashah,

Manaviat

et al. 2023

Preprint

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Background To evaluate changes in central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and foveal vessel density (VD) in deep and superficial capillary plexuses (DCP and SCP) 30 days after intravitreal bevacizumab (IVB) injection in eyes with diabetic macular edema (DME). Methods A prospective observational study on 25 eyes of 25 patients who were candidates of intravitreal anti-VEGF injection for the treatment of DME was conducted. After conducting a comprehensive ophthalmic examination, using optical coherence tomography angiography (OCTA) and enhanced depth imaging OCT, we measured CMT, SFCT, and foveal VD in DCP and SCP. In addition, a blood sample was drawn from every patient to determine baseline hemoglobin A1c levels. One month after a single IVB injection, all the parameters were reassessed. Results Mean age of the included patients was 59.56 ± 9.74 years. One month following bevacizumab injection, mean CMT, SFCT, VD in superficial capillary plexus, and VD in deep capillary plexus layer significantly (P < 0.05) decreased by 10.03% ± 5.53%, 8.18% ± 3.39%, 3.06% ± 6.98%, 3.65% ± 6.41%, respectively. Best corrected visual acuity (BCVA; LogMAR) was also improved significantly. Patients with HbA1c level ≤ 7 at baseline showed a larger decrease in CMT (P = 0.02) with no significant difference in other parameters. The decrease in LogMAR BCVA after treatment showed a negative correlation with pre-treatment SFCT and a positive correlation with the decrease in foveal VD in SCP (rho = -0.42, P = 0.04, and rho = 0.44, P = 0.03, respectively). Spearman correlation analysis showed no significant association between the changes in CMT, SFCT, and VD in superficial or deep capillary plexuses. Patients with better anatomical response to the treatment (CMT reduction ≥ 10%) had significantly lower SFCT and higher CMT values at baseline. Conclusions Significant functional and anatomical improvements were evident one month after IVB injection in patients with DME. Better glycemic control could result in a significantly larger reduction in the CMT of eyes with DME. Anatomical improvements were not correlated with changes in other assessed variables. Thinner SFCT at baseline could be attributed to better functional and anatomical response in these patients.

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“…Chronic DME can also lead to structural disorganization of retinal inner layers (DRIL) due to glial and neuronal cell death. 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].…”

Section: Müller Cells In Drmentioning

confidence: 99%

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

et al. 2022

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Diabetic retinopathy is a neurovascular complication of diabetes and the main cause of vision loss in adults. Glial cells have a key role in maintenance of central nervous system homeostasis. In the retina, the predominant element is the Müller cell, a specialized cell with radial morphology that spans all retinal layers and influences the function of the entire retinal circuitry. Müller cells provide metabolic support, regulation of extracellular composition, synaptic activity control, structural organization of the blood–retina barrier, antioxidant activity, and trophic support, among other roles. Therefore, impairments of Müller actions lead to retinal malfunctions. Accordingly, increasing evidence indicates that Müller cells are affected in diabetic retinopathy and may contribute to the severity of the disease. Here, we will survey recently described alterations in Müller cell functions and cellular events that contribute to diabetic retinopathy, especially related to oxidative stress and inflammation. This review sheds light on Müller cells as potential therapeutic targets of this disease.

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Indicators of Visual Prognosis in Diabetic Macular Oedema

Cited by 16 publications

References 119 publications

Predictive effect of TCED-HFV grading and imaging biomarkers on anti-VEGF therapy in diabetic macular edema

Predictive effect of TCED-HFV grading and imaging biomarkers on anti-VEGF therapy in diabetic macular edema

Changes in central retinal and choroidal OCT/OCTA parameters following intravitreal bevacizumab injection in diabetic macular edema

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

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