OCT-based biomarkers for predicting treatment response in eyes with centre-involved diabetic macular oedema treated with anti-VEGF injections: a real-life retina clinic-based study

Abstract

Background/aimsTo determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections.MethodsThis is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid.ResultsThe presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness.Conclusion and relevanceBaseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO.

Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses – An Updated Review

“…51 A recent retrospective study also showed that the presence of DRIL associated with a worse baseline and final VA despite anti-VEGF injections. 52 Reversal of the odds of having DRIL also correlated with DR severity. 53 It is likely that the presence of DRIL is a poor prognostic indicator, but the interpretation in the presence of DME is difficult.…”

“…Studies have demonstrated that the eyes with DRIL were at a nearly 8-times greater risk of poor visual recov-ery, 50 resolution of DRIL was indicative of better visual improvement, and persistent DRIL after resolution of DME was associated with a less favorable outcome 51 . A recent retrospective study also showed that the presence of DRIL associated with a worse baseline and final VA despite anti-VEGF injections 52 . Reversal of the odds of having DRIL also correlated with DR severity 53 .…”

OCT-Based Biomarkers are Associated with Systemic Inflammation in Patients with Treatment-Naïve Diabetic Macular Edema

“…As shown in Fig. 1, IRC size was graded qualitatively as no cyst, mild, moderate, or severe, according to previous research [35,36].…”

“…(1) reflectivity similar to the retinal nerve fiber layer; (2) diameter less than 30 lm; (3) no backshadowing. The number of HRFs was counted manually [18,19,35,36].…”

Progress of Imaging in Diabetic Retinopathy—From the Past to the Present

“…Association of macular non-perfusion assessed by FA and central subfield thickness measured with OCT was examined [ 71 ]. OCT has elucidated numerous changes and understanding of this pathology in DME, such disorganization of retinal inner layers (DRIL) [ 72 , 73 ], hyper-reflective foci [ 54 ], or that disruption of Elipsoid zone or ELM indicates macular dysfunction [ 74 , 75 , 76 ]. The application of each imaging modality to any stages of DR in clinical settings is reviewed and summarized in Table 2 .…”