Regional Variety of Reduction in Retinal Thickness of Diabetic Macular Edema after Anti-VEGF Treatment

Yamada, Yutaka; Takamura, Yoshihiro; Matsumura, Takeshi; Gozawa, Makoto; Morioka, Masakazu; Inatani, Masaru

doi:10.3390/medicina58070933

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…[ 2 , 3 , 17 , 18 ] Allingham et al reported finding an improvement rate for FA leakage after anti-VEGF treatment was 45.5% for diffuse edema and 17.9% for focal edema, which indicates that anti-VEGF treatment was less effective for focal edema that involves MAs. [ 3 ] Yamada et al reported that higher capillary mass density weakens the effect of anti-VEGF on retinal edema, based on the relationship between capillary mass density measured from fluorescence fundus angiography and local retinal thickness by OCT. [ 12 , 13 ] Their method evaluates the state of local retinal thickness better than our study. Although our study uses sector retinal thickness, we were able to confirm with a simple method that the number of MAs is associated with the efficacy of anti-VEGF therapy.…”

Section: Discussionmentioning

confidence: 67%

“…Several studies have reported that the efficacy of anti-VEGF treatments varies depending on the pathogenesis of the retinal edema. [3,[11][12][13] Focal edema is defined as edema around the MA caused by a leaking MA. [2,3,17,18] Allingham et al reported finding an improvement rate for FA leakage after anti-VEGF treatment was 45.5% for diffuse edema and 17.9% for focal edema, which indicates that anti-VEGF treatment was less effective for focal edema that involves MAs.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have reported on the efficacy of the anti-vascular endothelial growth factor (VEGF) treatment for DME that involves the fovea. [6][7][8] Although it has been reported that anti-VEGF treatment efficacy differs depending on whether the pathogenesis of the DME is focal edema involving MAs or diffuse edema, [9][10][11][12][13] the details remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Effect of microaneurysms on the anti-VEGF treatment for diabetic macular edema: A retrospective cross-sectional study

Watanabe,

Takashina,

Nakano

2023

Medicine

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Although anti-vascular endothelial growth factor (VEGF) treatment is effective for treating diabetic macular edema (DME), the effect of the microaneurysm (MA) status on the therapeutic efficacy of an anti-VEGF treatment remains unclear. Our current study investigated the effects of the number and the presence or absence of leaking MAs on DME and the efficacy of anti-VEGF therapy. A total of 51 eyes of 47 DME patients were administered anti-VEGF treatment. Fluorescence angiography results were used to determine the number of MAs and the presence or absence of leakage, with these findings matched to the optical coherence tomography maps. The correlation between the number of MAs and the retinal thicknesses and the influence of the leaking MAs was examined in order to definitively determine the effect of the anti-VEGF treatment. There was a correlation between the number of MAs and the retinal thickness of the sector in both the 6 mm (correlation coefficients: 0.42) and 3 mm (0.34) sectors (P < .001). There was also a correlation between the number of MAs and the retinal thickness in both the 6 mm (0.31) and 3 mm (0.24) sectors after undergoing the treatment (P < .01). There was a significant difference between the mean thickness of the leaking versus the non-leaking MAs in the 6 mm (388 ± 87 μm) and 3 mm (477 ± 108 μm) sectors before treatment (P < .01). There was also a significant difference for the retinal thickness between the sectors with and without leaking MAs after the treatment (P < .01). The degree of retinal edema before treatment is associated with the number of MAs and the presence of leaking MAs. Anti-VEGF treatment is less effective for focal macular edema with large numbers of MAs, which includes leaking MAs.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of microaneurysms on the anti-VEGF treatment for diabetic macular edema: A retrospective cross-sectional study

Watanabe,

Takashina,

Nakano

2023

Medicine

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“…In DME treatment, anti-VEGF therapy is effective for reducing the retinal thickness and decreasing the size of edematous areas; however, residual focal edema frequently remains, as seen in 65.8% of cases after the first injection [ 48 ]. An analysis using a 3D mode OCT map wherein an edematous area was divided into 100 sections showed that the reduction in retinal thickness after anti-VEGF therapy varied in regions of the DME [ 49 ]. A 10–20% reduction in retinal thickness accounted for approximately 40% of the total edematous areas, whereas only 6.4% of the edematous areas showed a reduction in retinal thickness of 30% or more.…”

Section: Clinical Role Of Mas In the Management Of Dr And Dmementioning

confidence: 99%

“…These results suggest that the edema-improving effect of anti-VEGF therapy varies by site and that some sites are less responsive than others. Notably, the MA density was higher in refractory areas, which was also where the reduction in retinal thickness after anti-VEGF therapy was minimal [ 49 ]. Additionally, the areas with residual edema after anti-VEGF treatment had a higher density of MAs than areas with improvement in edema [ 48 ].…”

Section: Clinical Role Of Mas In the Management Of Dr And Dmementioning

confidence: 99%

Role of Microaneurysms in the Pathogenesis and Therapy of Diabetic Macular Edema: A Descriptive Review

2023

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Background and Objectives: This study aims to elucidate the role of microaneurysms (MAs) in the pathogenesis and treatment of diabetic retinopathy (DR) and diabetic macular edema (DME), the major causes of acquired visual impairment. Materials and Methods: We synthesized the relevance of findings on the clinical characteristics, pathogenesis, and etiology of MAs in DR and DME and their role in anti-vascular endothelial growth factor (VEGF) therapy. Results: MAs, a characteristic feature in DR and DME, can be detected by fluorescein angiography, optical coherence tomography (OCT) and OCT angiography. These instrumental analyses demonstrated a geographic and functional association between MA and ischemic areas. MA turnover, the production and loss of MA, reflects the activity of DME and DR. Several cytokines are involved in the pathogenesis of MAs, which is characterized by pericyte loss and endothelial cell proliferation in a VEGF-dependent or -independent manner. Ischemia and MAs localized in the deep retinal layers are characteristic of refractory DME cases. Even in the current anti-VEGF era, laser photocoagulation targeting MAs in the focal residual edema is still an effective therapeutic tool, but it is necessary to be creative in accurately identifying the location of MAs and performing highly precise and minimally invasive coagulation. Conclusions: MAs play a distinctive and important role in the pathogenesis of the onset, progression of DR and DME, and response to anti-VEGF treatment. Further research on MA is significant not only for understanding the pathogenesis of DME but also for improving the effectiveness of treatment.

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Turnover of Microaneurysms After Intravitreal Injections of Faricimab for Diabetic Macular Edema

Takamura,

Yamada,

Morioka

et al. 2023

Invest. Ophthalmol. Vis. Sci.

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Purpose Microaneurysm (MA) plays an important role in the pathogenesis of diabetic macular edema (DME) progression and response to anti-vascular endothelial growth factor (VEGF) therapy. This study aimed to investigate the effect of faricimab, a bispecific antibody against angiopoietin-2 and VEGF, on the number of MAs and their turnover in the treatment of DME. Methods We included that patients with DME who underwent three monthly injections of faricimab in one eye, with the other eye as control. We examined central retinal thickness (CRT) based on optical coherence tomography (OCT) and best-corrected visual acuity. Turnover, including loss and newly formed MAs, and the total number of MAs were counted based on merged images of the OCT map and fluorescein angiography. Results We enrolled 28 patients with DME. After 3 monthly injections of faricimab, CRT significantly improved, 66.0 ± 16.2% of MAs disappeared, and 6.71 ± 5.6% of new MAs were generated, resulting in total reduction to 40.7 ± 15.2%. In the treated eyes, MA disappearance ( P < 0.0001) and turnover ( P = 0.007) were significantly greater, and new formation was smaller ( P < 0.0001) than in non-treated eyes. The size of the retained MAs decreased after treatment. Microaneurysm turnover was not significantly different between areas with and without edema before treatment. Conclusions In the process of improving edema in DME with faricimab, MAs shrink and disappear, and formation of MAs are inhibited, resulting in decreased total number of MAs. Intravitreal administration of faricimab suppresses vascular permeability and improves vascular structure.

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Regional Variety of Reduction in Retinal Thickness of Diabetic Macular Edema after Anti-VEGF Treatment

Cited by 7 publications

References 24 publications

Effect of microaneurysms on the anti-VEGF treatment for diabetic macular edema: A retrospective cross-sectional study

Effect of microaneurysms on the anti-VEGF treatment for diabetic macular edema: A retrospective cross-sectional study

Role of Microaneurysms in the Pathogenesis and Therapy of Diabetic Macular Edema: A Descriptive Review

Turnover of Microaneurysms After Intravitreal Injections of Faricimab for Diabetic Macular Edema

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