Relationship Between Final Visual Acuity and Optical Coherence Tomography Findings in Patients with Diabetic Macular Edema Undergoing Anti-VEGF Therapy

Abstract

Objectives: To identify the prevalence of findings in optical coherence tomography (OCT) sections before intravitreal anti-VEGF treatment in patients with diabetic macular edema (DME), and to evaluate the relationship between these findings and final visual acuity and number of injections. Materials and Methods: This retrospective study included 296 eyes of 191 patients (104 male, 87 female) who started intravitreal ranibizumab treatment after being diagnosed with DME in the retina unit between January 2013 and April 2017 were included the study. Spectral domain OCT findings at the time of presentation such as presence of serous macular detachment (SD), vitreomacular traction (VMT), and epiretinal membrane (ERM) were recorded. In addition, the regularity of the ellipsoid zone (EZ) and inner retinal layers was also studied. Results: The mean central retinal thickness measured in SD-OCT was 449±81 μm before treatment and 350±96 μm after treatment (p<0.001). SD was detected in 155 eyes (52.4%), ERM in 67 eyes (22.6%), and VMT in 9 eyes (3%). Thirty eyes (10.1%) had disorganization of the retinal inner layers (DRIL) and 54 eyes (18.2%) had EZ deterioration. The presence of ERM, EZ irregularity, and DRIL were associated with significantly lower final visual acuity (p<0.0001), while there was no relationship between pre-treatment SD and final visual acuity (p=0.11). Injection number was higher in eyes with SD and ERM compared to those without, but this difference was statistically significant only in the presence of SD (p=0.01 and p=0.59, respectively). There was no difference in injection number according to EZ irregularity or presence of DRIL. Conclusion: The coexistence of SD with DME was associated with increased need for treatment but not with final visual acuity. EZ irregularities, DRIL, and ERM are findings that negatively affect visual acuity.

Prognostic biomarkers of chronic diabetic macular edema treated with a fluocinolone acetonide intravitreal implant

“…However, a small percentage of eyes achieving vision stability was also observed in group 2. The fact that DRIL may gradually regress after DME resolution, as observed in our patients (Figures 4 and 5), could explain these results [18,21]. Indeed, there was a statistically significant difference in the evolution of prognostic biomarkers between the two groups, supporting the idea that FAc implants may improve retinal integrity.…”

“…DRIL is a noninvasive parameter that seems to be a reliable predictor of visual outcomes in eyes with DME [17,18]. A plausible explanation for this fact is that DRIL may reflect disorganization or compromised function of some anatomical structures considered critical for the transmission of visual information, such as bipolar, Müller, and horizontal cells [14,15,21]. In fact, the communication pathway between photoreceptors and ganglion cells mostly depends on bipolar cell integrity [22,23].…”

“…The literature suggests that the EZ layer reflects photoreceptor integrity and can also be considered an important predictor of visual prognosis in various retinal diseases [21,[24][25][26][27][28]. Similar to DRIL, several studies have suggested that EZ integrity is related to better visual outcomes after anti-VEGF and dexamethasone implant treatment [6,14,21].…”

Indicators of Visual Prognosis in Diabetic Macular Oedema

“…The presence of DRIL may also be associated with other OCT changes like EZ and ELM disruption, enlarged foveal avascular zone (FAZ) on OCTA. DRIL is associated with other functional changes including subnormal multifocal electroretinogram, impaired contrast sensitivity and visual field tests [ 75 , 76 , 77 , 78 , 79 , 80 , 81 ].…”

Πολυμεταβλητή Ανάλυση Αποτελεσματικότητας Αντιαγγειογενετικών Παραγόντων Στο Διαβητικό Οίδημα Της Ωχράς Κηλίδας

“…Προηγούμενες μελέτες είχαν εξετάσει το ρόλο των υπερανακλαστικών κοκκίων ως πιθανό «βιοδείκτη» για την πρόβλεψη της οπτικής οξύτητας σε ασθενείς με διαβητικό οίδημα ωχράς [49][50][51][52][53][54][55][56][57][58], ενώ η κατάσταση της ελλειψοειδούς ζώνης είναι γνωστός προγνωστικός παράγοντας της οπτικής οξύτητας σε ασθενείς με διαβητικό οίδημα ωχράς [59][60][61][62][63]. Ωστόσο, η θέση της HbA1c σε σχέση με την οπτική οξύτητα και την απάντηση στη θεραπεία με αντι-αγγειογενετικούς παράγοντες παραμένει αμφιλεγόμενη.…”