Visual and Morphologic Outcomes of Intravitreal Ranibizumab for Diabetic Macular Edema Based on Optical Coherence Tomography Patterns

Seo, Kyung Hoon; Yu, Seung-Young; Kim, Moo‐Sang; Kwak, Hyung Woo

doi:10.1097/iae.0000000000000770

Cited by 97 publications

(120 citation statements)

References 21 publications

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“…A study by Reznicek et al 37 showed that in patients being treated with RBZ the IS-OS layer defect actually improved; with previous animal models suggesting the possibility of remodelling or regeneration of the photoreceptor layer, it is interesting to suggest that OCT disruptions in this layer are not static but fluid in response to treatment. Two recent studies by Seo et al 38 and Kang et al 39 showed similar regenerative effects of the IS-OS and ELM layer in all subtypes of oedema—cystoid, SRF, and diffuse.…”

Section: Defining Responsementioning

confidence: 69%

Predicting outcomes to anti-vascular endothelial growth factor (VEGF) therapy in diabetic macular oedema: a review of the literature

Ashraf

Souka²,

Adelman³

2016

Br J Ophthalmol

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Diabetic macular oedema affects visual acuity to a varying degree. The current treatment of choice is intravitreal anti-vascular endothelial growth factor (VEGF) that has proven both its anatomical and visual efficacy in several large randomised clinical trials (RCTs). Although most patients respond well to anti-VEGF agents, some, however, show a moderate or even poor response. There is no clear consensus as to how to manage these patients, or define them. In addition, identifying early in the course of treatment which patients will respond and which patients will not is paramount to any personalised treatment regimen. Most large RCTs such as RESTORE and Protocol I have attempted post hoc analyses to identify demographic, clinical, optical coherence tomography (OCT) and fluorescein angiography findings that might predict patient response. Although some factors were found to be predictive, the lack of uniformity between the different RCTs means that no consensus exists as to which of these factors can be reliably used. This review looks at the large diabetic macular oedema RCTs such as RESTORE, Protocol I, READ-2 and BOLT in an attempt to identify common prognostic indicators between the various studies. We also attempted to look at several other OCT parameters such as the inner segment-outer segment (IS-OS) layer, the external limiting membrane layer, and choroidal thickness to help determine whether they can truly predict visual outcomes in patients being treated with anti-VEGF therapy. Finally, we provide a simplified summary about which factors might be relevant in clinical practice to help guide physicians in treatment decisions.

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Section: Defining Responsementioning

confidence: 69%

Predicting outcomes to anti-vascular endothelial growth factor (VEGF) therapy in diabetic macular oedema: a review of the literature

Ashraf

Souka²,

Adelman³

2016

Br J Ophthalmol

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“…A few studies have shown these biomarkers of the photoreceptor status as predictors of visual outcomes after anti-VEGF therapy313233. However, the effects of anti-VEGF therapy on photoreceptor damage are controversial343536.…”

mentioning

confidence: 99%

Restoration of foveal photoreceptors after intravitreal ranibizumab injections for diabetic macular edema

Mori

Suzuma

Uji

et al. 2016

Sci Rep

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Anti-vascular endothelial growth factor drugs are the first-line treatment for diabetic macular edema (DME), although the mechanism of the visual acuity (VA) improvement remains largely unknown. The association between photoreceptor damage and visual impairment encouraged us to retrospectively investigate the changes in the foveal photoreceptors in the external limiting membrane (ELM) and ellipsoid zone (EZ) on spectral-domain optical coherence tomography (SD-OCT) images in 62 eyes with DME treated with intravitreal ranibizumab (IVR) injections. The transverse lengths of the disrupted EZ and ELM were shortened significantly (P < 0.001 and P = 0.044, respectively) at 12 months. The qualitative investigation also showed restoration of the EZ and ELM lines on SD-OCT images. The EZ at 12 months lengthened in 34 of 38 eyes with discontinuous EZ and was preserved in 16 of 21 eyes with complete EZ at baseline. VA improvement was positively correlated with shortening of the disrupted EZ at 12 months (ρ = 0.463, P < 0.001), whereas the decrease in central subfield thickness was associated with neither VA improvement nor changes in EZ status (ρ = 0.215, P = 0.093 and (ρ = 0.209, P = 0.103, respectively). These data suggested that photoreceptor restoration contributes to VA improvement after pro re nata treatment with IVR injections for DME independent of resolved retinal thickening.

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“…The absence of limiting boundaries creates a particular pattern region commonly designed by ophthalmologists as a "sponge-like" appearance [65], as represented in Figure 2.20. As a result, the thickness of the lower retina region increases, which consequently leads to an increment of the entire normal retinal thickness, modifying significantly the normal morphology and tissue patterns.…”

Section: Diffuse Retinal Thickening -Drtmentioning

confidence: 99%

“…Typically, the SRD type is characterized by a dome shape at the inferior retinal layers whereas the CME type is defined by the presence of the intraretinal cystoid spaces of low reflectivity separated by highly reflective boundaries that represent the intraretinal cystoid-like cavities [48]. Finally, the DRT type is commonly characterized as a "sponge-like" swelling appearance as a result of a regional fluid spread with reduced intraretinal reflectivity [7,65]. Despite the fact that these three types derive from the same cause, the leak of fluid, their characteristics and visual appearance within the retinal layers are enormously different, as described in detail in the sections: SRD in section 2.4.1, CME in section 2.4.2 and, finally, the CME in section 2.4.3.…”

Section: Macular Edema Typesmentioning

confidence: 99%

Automatic macular edema identification and characterization using OCT images

Samagaio

Estévez

Moura

et al. 2018

Computer Methods and Programs in Biomedicine

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A Tomografia de Coerência Óptica (TCO) consiste numa técnica de imagem médica não invasiva e ausente do contacto directo com o paciente que avalia in vivo a histopatologia do tecido. Esta tem sido amplamente utilizada no diagnóstico médico para identificar diversas patologias, não só associadas ao órgão em estudo no presente projecto, mas também a outras doenças em geral.A Retinopatia Diabética (RD) e a Degeneração Macular Relacionada à Idade (DMRI) são atualmente consideradas como duas das principais doenças oculares relacionadas com a perda de visão nos países desenvolvidos. Estas doenças têm em comum o acúmulo de líquido dentro do tecido retiniano, formando o Edema Macular (EM). A detecção e caracterização da acumulação de líquido intra-retiniano na mácula constitui uma questão oftalmológica crucial, dado que este fornece informações úteis na identificação e no diagnóstico dos diferentes tipos de EM, indicando consequentemente a gravidade da doença. Estes tipos de edemas da retina são clinicamente definidos, segundo a classificação de referência do campo, como: Descolamento Seroso Exsudativo da Retina (DSER), Edema Macular Difuso (EMD) e Edema Macular Cistoide (EMC).O presente trabalho visa o desenvolvimento de um sistema automático capaz de detectar e caracterizar os três tipos de EM usando imagens TCO. Este sistema de Diagnóstico Assistido por Computador (DAC) usará diferentes estratégias as quais combinam técnicas de processamento de imagem e de aprendizagem máquina com o conhecimento clínico. No caso do reconhecimento dos edemas DSER e EMC, espera-se a aplicação de abordagens com base nos diferentes limiares de intensidades característicos destes edemas, enquanto que para os EMD, dada a sua complexidade e aparência regional, deve ser aplicada uma estratégia de aprendizagem para explorar propriedades características dessa região.Esta solução permitirá assegurar a redução de custos relacionados com operações cirúrgicas e tratamento clínico aumentando assim a qualidade do diagnóstico, reduzindo a subjectividade inter-especialistas culminando na melhora da qualidade de vida do paciente. A produtividade e eficiência dos especialistas irá igualmente aumentar dado que esta solução irá o seu trabalho será facilitado. AbstractThe Optical Coherence Tomography (OCT) consists of a non-invasive and contactless medical image technique that evaluates in vivo the histopathology of the tissue. It has been widely used in medical diagnosis to identify a large range of pathologies, not only associated to the organ under the present study but also with other diseases in general.The diabetic retinopathy (DR) and the Age-related Macular Degeneration (AMD) are considered the two major eye diseases that are currently related with the vision loss in the developed countries. These diseases have in common the fluid accumulation within the retinal tissue round the macular region, forming the Macular Edema (ME). The detection and characterization of the intraretinal fluid accumulation constitutes a crucial ophthalmological issue as i...

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Visual and Morphologic Outcomes of Intravitreal Ranibizumab for Diabetic Macular Edema Based on Optical Coherence Tomography Patterns

Cited by 97 publications

References 21 publications

Predicting outcomes to anti-vascular endothelial growth factor (VEGF) therapy in diabetic macular oedema: a review of the literature

Predicting outcomes to anti-vascular endothelial growth factor (VEGF) therapy in diabetic macular oedema: a review of the literature

Restoration of foveal photoreceptors after intravitreal ranibizumab injections for diabetic macular edema

Automatic macular edema identification and characterization using OCT images

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