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Ammari W, Chaabene H, Messaoud R. [Anatomical and functional outcomes of the "3+PRN" therapeutic protocol in the treatment of diabetic macular edema]. J Fr Ophtalmol 2024; 47:104234. [PMID: 38875945 DOI: 10.1016/j.jfo.2024.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/04/2024] [Accepted: 03/12/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To evaluate the anatomical and functional results of the "3+PRN" protocol in the treatment of diabetic macular edema (DME), determine the predictive factors for good final visual acuity, and compare it to other protocols. MATERIALS AND METHODS We conducted a retrospective, descriptive, comparative, cross-sectional study of patients with DME, which we dubbed HTSM. All patients were treated with three monthly initial intravitreal injections (IVT) of 1.25mg bevacizumab and followed according to the pro re nata (PRN) protocol for a period of 3years. The protocol was based on a monthly monitoring schedule for the first 3months, then increasingly spaced out over time. "On-demand" treatment was indicated with resumption of bevacizumab IVT in the event of worsening of DME. RESULTS A total of 52 patients were included. The mean age was 65years. Type 2 was the most frequently observed type of diabetes. The mean duration of the PRN protocol was 6months, and the mean number of injections was 6. The mean visual acuity (VA), initially 1/10, improved to 3/10 by the conclusion of the 3+PRN protocol, with an improvement of more than 5 letters in 77.6% of cases. The mean initial central macular thickness (CMT) was 451.5μm. The final mean EMC decreased to 298.5μm, which corresponds to a reduction of 153μm compared to the initial value. The mean subfoveal choroidal thickness, initially 304.2μm, decreased to a mean of 284.5μm at completion. Comparative analysis of the results before and after the PRN protocol confirmed the existence of a statistically significant correlation between VA and CMT (P<0.05). No correlation was observed between age and visual acuity or between initial and final VA. The analysis of the various tomographic parameters and VA revealed a significantly better visual improvement in the group in whom the external limiting membrane (MLE) and ellipsoid zone (ZE) were intact (P=0.04), as well as in the group in whom serous retinal detachment (SRD) was absent (P<0.001). Posterior vitreous detachment (PVD) was the most frequently observed vitreomacular anomaly. The final VA was similar in the groups with and without PVD (P=0.04). CONCLUSION The 3+PRN protocol is effective both functionally and tomographically in the treatment of DME. Various tomographic parameters might influence therapeutic efficacy. However, further in-depth studies are needed to better investigate these parameters.
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Affiliation(s)
- W Ammari
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie.
| | - H Chaabene
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
| | - R Messaoud
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
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Limon DU, Kaplan FB, Saygın I, Önder Tokuç E, Kutlutürk Karagöz I, Kanar HS, Sevik MO, Yayla U, Çelik E, Sönmez A, Aykut A, Kumral Türkseven E, Erçalık NY, Oncu Aydın Ö, Bozkurt E, Aydoğan T, Emengen EB, Özkaya A, Açıkalın Öncel B, Yenerel NM, Şahin Ö, Karabaş L. One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13. Semin Ophthalmol 2024; 39:460-467. [PMID: 39087722 DOI: 10.1080/08820538.2024.2324450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. METHODS In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. RESULTS 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). CONCLUSIONS In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.
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Affiliation(s)
- Dr Utku Limon
- Ümraniye Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Fatih Bilgehan Kaplan
- Fatih Sultan Mehmet Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Işılay Saygın
- Ümraniye Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Ecem Önder Tokuç
- Derince Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Kocaeli, Turkey
| | - Işıl Kutlutürk Karagöz
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Hatice Selen Kanar
- Kartal Dr. Lütfi Kırdar City Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uğur Yayla
- Derince Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Kocaeli, Turkey
| | - Erkan Çelik
- Department of Ophthalmology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ayşe Sönmez
- Fatih Sultan Mehmet Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Esra Kumral Türkseven
- Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Nimet Yeşim Erçalık
- Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Özlem Oncu Aydın
- Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Erdinç Bozkurt
- Ümraniye Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Tuğba Aydoğan
- Ümraniye Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Ece Başaran Emengen
- Department of Ophthalmology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Abdullah Özkaya
- Department of Ophthalmology, Memorial Şişli Hospital, Istanbul, Turkey
| | - Banu Açıkalın Öncel
- Fatih Sultan Mehmet Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Nursal Melda Yenerel
- Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Kocapınar Y, Kaplan FB, Demirciler Sönmez A, Açıkalın B. Evaluation of the efficacy of anti-vascular endothelial growth factors in diabetic macular edema with retinal inner and outer layers disorganization. Acta Diabetol 2023; 60:1391-1398. [PMID: 37378699 DOI: 10.1007/s00592-023-02121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Abstract
AIMS This study aims to compare the effectiveness of treatment between anti-vascular endothelial growth factor (anti-VEGF) agents in diabetic macular edema (DME) patients with disorganization of retinal inner layers (DRIL). Epiretinal membrane, serous macular detachment, ellipsoid zone (EZ) disorder, external limiting membrane (ELM) disorder, and hyperreflective foci were also examined. METHODS Patients treated for DME and also had DRIL were included in the study. The study design was retrospective and cross-sectional. The complete ophthalmologic records and imaging were scanned at the beginning, 3rd-month, 6th-month, and 12th-month follow-up, and the treatments administered were recorded. Anti-VEGF agents administered to the patients were examined in three groups: bevacizumab, ranibizumab, and aflibercept. RESULT A total of 141 eyes of 100 patients were included in our study. One hundred and fifteen eyes (81.6%) had a BCVA of 0, 5, or less at the beginning. There was no statistically significant difference between the three groups regarding initial BCVA and CMT and the change in BCVA and CMT at the beginning and the 12th month (p > 0.05). There was a negative correlation between EZ and ELM disorders in patients and the change in BCVA at 12 months (r: 0.45 p < 0.001, r: 0.32 p < 0.001, respectively). The number of injections over five was positively correlated with the change in CMT but not with BCVA (r: - 2.35 p = 0.005 and r: 0.147 p = 0.082, respectively). CONCLUSIONS No statistically significant difference was found between anti-VEGF agents when treating DME patients with DRIL. In addition, we have shown that anatomically better results were obtained in those who had five or more injections, although not in terms of BCVA.
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Affiliation(s)
- Yıldırım Kocapınar
- Department of Ophthalmology, Siirt Training and Research Hospital, Yeni mah. Güres Cad. Hastane Sok, Merkez, 56000, Siirt, Turkey.
| | - Fatih Bilgehan Kaplan
- Department of Ophthalmology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Ataşehir, 34752, Istanbul, Turkey
| | | | - Banu Açıkalın
- Department of Ophthalmology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Ataşehir, 34752, Istanbul, Turkey
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Nassar GA, Maqboul IM, El-Nahry AG, Hassan LM, Shalash AB. Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study. Int J Retina Vitreous 2023; 9:32. [PMID: 37202824 DOI: 10.1186/s40942-023-00469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND To compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA). METHODS A cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings. RESULTS The study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels. CONCLUSION The morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.
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Park J, Felfeli T, Kherani IZ, Altomare F, Chow DR, Wong DT. Prevalence and clinical implications of subretinal fluid in retinal diseases: a real-world cohort study. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001214. [PMID: 37039095 PMCID: PMC9945046 DOI: 10.1136/bmjophth-2022-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023] Open
Abstract
Background/aimsTo characterise the baseline prevalence of subretinal fluid (SRF) and its effects on anatomical and visual acuity (VA) outcomes in diabetic macular oedema (DME) and retinal vein occlusion (RVO) following anti-vascular endothelial growth factor (VEGF).MethodsThis is a retrospective cohort study of 122 DME and 54 RVO patients who were initiated on anti-VEGF therapy with real-world variable dosing. The DME and RVO cohorts were subclassified based on the presence of SRF at presentation. Snellen VA was measured and converted to logarithm of the minimum angle of resolution (LogMAR). Changes in VA and central subfield thickness (CST) were assessed up to 24 months.ResultsSRF was present in 22% and 41% in DME and RVO patients, respectively. In the DME subcohort, eyes with SRF showed an improvement of 0.166 logMAR (1.7 Snellen chart lines) at 12 months and 0.251 logMAR (2.6 Snellen chart lines) at 24 months, which were significantly greater compared with those of the non-SRF group. A significantly greater reduction in CST was noted in the SRF eyes compared with the non-SRF eyes at 3 months and 1 month in the DME and RVO subcohorts, respectively.ConclusionBaseline SRF is a good marker for a greater reduction in CST in both DME and RVO, but an improvement in VA associated with SRF may be only noted in DME.
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Affiliation(s)
- Jeff Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Z Kherani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
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Sirakaya E, Kilic D, Aslan Sirakaya H. Comparison of intravitreal ranibizumab, aflibercept and bevacizumab therapies in diabetic macular edema with serous retinal detachment. Eur J Ophthalmol 2022; 33:1459-1466. [PMID: 36482707 DOI: 10.1177/11206721221144797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To compare the effects of ranibizumab, aflibercept and bevacizumab treatments in treatment-naive diabetic macular edema(DME) patients with serous retinal detachment(SRD). Material and methods This is a retrospective, comparative study. In a sample of 86 eyes of 86 untreated DME patients with accompanying SRD, 23 patients were treated with ranibizumab (IVR), 28 patients with aflibercept (IVA), and 35 patients with bevacizumab (IVB). All were injected intravitreally once a month for a 3-month loading dose. Subsequently, all participants were evaluated every months and if neccessary they received additional intravitreal treatments.Mean changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and SRD height over the 6-months study period were compared. Results At baseline, the groups did not differ in mean BCVA,CRT and SRD height. During the first 3 months, in IVA group the mean decrease in CRT and SRD height were significantly more than in the other two groups ( p < 0.05 for all). However, these differences disappeared at 6 months.The number of injections was similar between the groups during the study period. Conclusion In patients with DME accompanied by SRD, IVA is a more advantageous option in terms of reduction in CRT and SRD height from baseline to 3 months. In the 6-month period of treatment, IVR, IVA and IVB therapies areanatomically and functionally similar and significant effective modalities.
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Affiliation(s)
- Ender Sirakaya
- Department of Ophthalmology, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
| | - Hatice Aslan Sirakaya
- Department of Internal Medicine, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
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Wang P, Hu Z, Hou M, Norman PA, Chin EK, Almeida DRP. Relationship Between Macular Thickness and Visual Acuity in the Treatment of Diabetic Macular Edema With Anti-VEGF Therapy: Systematic Review. JOURNAL OF VITREORETINAL DISEASES 2022; 7:57-64. [PMID: 37008395 PMCID: PMC9954155 DOI: 10.1177/24741264221138722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose: To examine the relationship between central macular thickness (CMT) measured by optical coherence tomography (OCT) and visual acuity (VA) in patients with center-involving diabetic macular edema (DME) receiving antivascular endothelial growth factor (anti-VEGF) treatment. Methods: Peer-reviewed articles from 2016 to 2020 reporting intravitreal injections of bevacizumab, ranibizumab, or aflibercept that provided data on pretreatment (baseline) and final retinal thickness (CMT) and visual acuity (VA) were identified. The relationship between relative changes was assessed via a linear random-effects regression model controlling for treatment group. Results: No significant association between the logarithm of the minimum angle of resolution (logMAR) VA and CMT was found in 41 eligible studies evaluating 2667 eyes. The observed effect estimate was a 0.12 increase (95% CI, −0.124 to 2.47) in logMAR VA per 100 µm reduction in CMT after treatment change. There were no significant differences in logMAR VA between the anti-VEGF treatment groups. Conclusions: There was no statistically significant relationship between the change in logMAR VA and change in CMT as well as no significant effect of the type of anti-VEGF treatment on the change in logMAR VA. Although OCT analysis, including measurements of CMT, will continue to be an integral part of the management of DME, further exploration is needed on additional anatomic factors that might contribute to visual outcomes.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, Queen’s University, Kingston, ON, Canada
| | - Zoe Hu
- Department of Radiology, Queen’s University, Kingston, ON, Canada
| | - Maggie Hou
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Eric K. Chin
- Retina Consultants of Southern California, Redlands, CA, USA
- Loma Linda University Medical Center, Veterans Affair Hospital, Loma Linda, CA, USA
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Hui VWK, Szeto SKH, Tang F, Yang D, Chen H, Lai TYY, Rong A, Zhang S, Zhao P, Ruamviboonsuk P, Lai CC, Chang A, Das T, Ohji M, Huang SS, Sivaprasad S, Wong TY, Lam DSC, Cheung CY. Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses - An Updated Review. Asia Pac J Ophthalmol (Phila) 2022; 11:247-257. [PMID: 34923521 DOI: 10.1097/apo.0000000000000468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Optical coherence tomography (OCT) is an invaluable imaging tool in detecting and assessing diabetic macular edema (DME). Over the past decade, there have been different proposed OCT-based classification systems for DME. In this review, we present an update of spectral-domain OCT (SDOCT)-based DME classifications over the past 5 years. In addition, we attempt to summarize the proposed OCT qualitative and quantitative parameters from different classification systems in relation to disease severity, risk of progression, and treatment outcome. Although some OCT-based measurements were found to have prognostic value on visual outcome, there has been a lack of consensus or guidelines on which parameters can be reliably used to predict treatment outcomes. We also summarize recent literatures on the prognostic value of these parameters including quantitative measures such as macular thickness or volume, central subfield thickness or foveal thickness, and qualitative features such as the morphology of the vitreoretinal interface, disorganization of retinal inner layers, ellipsoid zone disruption integrity, and hyperreflec-tive foci. In addition, we discuss that a framework to assess the validity of biomarkers for treatment outcome is essentially important in assessing the prognosis before deciding on treatment in DME. Finally, we echo with other experts on the demand for updating the current diabetic retinal disease classification.
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Affiliation(s)
- Vivian W K Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- Hong Kong Eye Hospital, Hong Kong, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- Hong Kong Eye Hospital, Hong Kong, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
| | - Haoyu Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- 2010 Retina & Macula Center, Kowloon, Hong Kong
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, China
- Shanghai Xin Shi Jie Eye Hospital, Shanghai, China
| | | | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSw, Australia
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Suber S Huang
- Retina Center of Ohio, Cleveland, OH, US
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, US
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Dennis S C Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
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Change of Optical Coherence Tomography Morphology and Associated Structural Outcome in Diabetic Macular Edema after Ranibizumab Treatment. J Pers Med 2022; 12:jpm12040611. [PMID: 35455727 PMCID: PMC9027951 DOI: 10.3390/jpm12040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, p = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, p = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, p = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112–36.623, p = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment.
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Sharma S, Karki P, Joshi SN, Parajuli S. Optical coherence tomography patterns of diabetic macular edema and treatment response to bevacizumab: a short-term study. Ther Adv Ophthalmol 2022; 14:25158414221074519. [PMID: 35387237 PMCID: PMC8977703 DOI: 10.1177/25158414221074519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The purpose of this study was to evaluate the short-term response of
intravitreal bevacizumab in diabetic macular edema (DME) and assess the
variation in treatment outcomes in different morphology patterns using
spectral domain–optical coherence tomography (SD-OCT). Objective: To study different morphological patterns of DME based on OCT and compare
their treatment response to bevacizumab. Methods: Hundred and twelve eyes of 112 patients with DME were included and treated
with intravitreal bevacizumab (1.25 mg/0.05 ml monthly for 3 months). The
morphological patterns of DME were classified on the basis of OCT into three
groups – diffuse retinal thickening (DRT), cystoid macular edema (CME), and
serous retinal detachment (SRD) – and changes in central macular thickness
(CMT) and best corrected visual acuity (BCVA) after treatment were
compared. Results: A total of 112 eyes with DME were included and consisted of 40 DRT, 37 CME,
and 35 SRD. Treatment with bevacizumab resulted in decrease in central
macular thickness and improvement in BCVA in all three groups. The baseline
visual acuity and CMT of DRT group was better than that of the other two
groups. The treatment outcome was measured in terms of CMT and BCVA. Change
in CMT was statistically significant among three groups and was found to be
better in DRT group (p < 0.05, 95% confidence interval).
However, there was statistically no significant variation between the three
groups regarding the change in BCVA (p = 0.169, 95%
confidence interval). Conclusion: Anatomic and visual improvement can be achieved by bevacizumab in all
patterns of DME. However, individual pattern may respond differently. DRT,
which appears to be the earliest form of DME, responds better than other
types. Thus, the pattern of macular edema shown by OCT may provide an
objective guideline in predicting the response of bevacizumab injection in
DME.
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Affiliation(s)
| | - Pratap Karki
- Department of Retina, B.P. Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Institute of Medicine, Kathmandu, Nepal
| | - Sagun Narayan Joshi
- Department of Retina, B.P. Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Institute of Medicine, Kathmandu, Nepal
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11
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Eraslan S, Yıldırım Ö, Dursun Ö, Dinç E, Orekici Temel G. Relationship Between Final Visual Acuity and Optical Coherence Tomography Findings in Patients with Diabetic Macular Edema Undergoing Anti-VEGF Therapy. Turk J Ophthalmol 2021; 50:163-168. [PMID: 32631004 PMCID: PMC7338745 DOI: 10.4274/tjo.galenos.2019.91962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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.
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Affiliation(s)
- Seher Eraslan
- Nevşehir State Hospital, Clinic of Ophthalmology, Nevşehir, Turkey
| | - Özlem Yıldırım
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Özer Dursun
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Erdem Dinç
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Gülhan Orekici Temel
- Mersin University Faculty of Medicine, Department of Biostatistics, Mersin, Turkey
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12
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SYSTEMIC FACTORS AND EARLY TREATMENT RESPONSE TO INTRAVITREAL INJECTION FOR DIABETIC MACULAR EDEMA: The Role of Renal Function. Retina 2021; 41:1275-1282. [PMID: 33141788 DOI: 10.1097/iae.0000000000003012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effect of systemic factors on early treatment response to intravitreal bevacizumab injection (IVBI) and intravitreal dexamethasone implant (IVDI) in patients with diabetic macular edema (DME). METHODS We reviewed the medical records of 117 treatment naïve DME patients who underwent IVBI. We divided the patients according to their IVBI response. An IVDI was performed in patients with poor response to IVBIs. We investigated the various systemic factors of diabetic patients and examined the relationship between systemic factors and the treatment response to IVBI and IVDI. RESULTS In a total of 117 treatment naïve DME eyes, 61 eyes (52.14%) were classified as IVBI responders. An IVDI was performed in 23 of 56 eyes with poor response to IVBI, and 17 eyes (73.91%) had a good response. Among various systemic factors of patients with diabetes, renal function (blood urea nitrogen, creatinine, and estimated glomerular filtration rate) showed a significant negative correlation with central subfield retinal thickness improvement after treatment (P < 0.05). However, there was no difference in HbA1C levels regarding the treatment response to IVBI and IVDI. CONCLUSION Renal function was significantly worse in patients with a poor response to IVBI and IVDI. Renal function could be used as a possible predictor for treatment response in certain patients with DME. Furthermore, for patients with DME with poor responses to anti-vascular endothelial growth factor or steroid treatments, assessment of renal function could help explain the poor treatment response.
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13
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Bong A, Doughty MJ, Button NF, Mansfield DC. On the relationship between visual acuity and central retinal (macular) thickness after interventions for macular oedema in diabetics: a review. Clin Exp Optom 2021; 99:491-497. [DOI: 10.1111/cxo.12393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/24/2015] [Accepted: 01/07/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Anna Bong
- Department of Vision Sciences, Glasgow‐Caledonian University, Glasgow, UK,
| | - Michael J Doughty
- Department of Vision Sciences, Glasgow‐Caledonian University, Glasgow, UK,
| | - Norman F Button
- Department of Vision Sciences, Glasgow‐Caledonian University, Glasgow, UK,
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14
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Usui-Ouchi A, Tamaki A, Sakanishi Y, Tamaki K, Mashimo K, Sakuma T, Ebihara N. Factors Affecting a Short-Term Response to Anti-VEGF Therapy in Diabetic Macular Edema. Life (Basel) 2021; 11:life11020083. [PMID: 33503815 PMCID: PMC7912394 DOI: 10.3390/life11020083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetic macular edema (DME) is a common cause of visual impairment in patients with diabetes. Although intravitreal anti-vascular endothelial growth factor (VEGF) injections were efficacious in clinical trials, several patients exhibited a poor response. This study aimed to compare clinical features between patients who were susceptible to intravitreal anti-VEGF injections for DME and those who were not. A single-center, retrospective study of 102 such patients was conducted (123 eyes; mean ± standard deviation age, 63.4 ± 10.8 years; 57.8% males). Systemic and ocular data, assessed at baseline and after a month, were compared between good (>20% decrease in central macular thickness (CMT)) and poor (≤20% decrease in CMT) responders using the Mann-Whitney U test/Fisher's exact test. Eighty-one eyes (65.9%) were good responders. The glycosylated hemoglobin level was higher (p = 0.011) in poor (7.5% ± 0.94%) than in good (7.04% ± 1.19%) responders. The foveal avascular zone was larger (p = 0.0003) in poor (0.67 ± 0.33 μm2) than in good (0.47 ± 0.23 μm2) responders. The number of microaneurysms in the pericapillary network was higher (p = 0.0007) in poor (2.7 ± 2.2) than in good (1.4 ± 2.0) responders. Baseline glycemic control and macular ischemia may be associated with the short-term response to intravitreal anti-VEGF injections.
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15
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Chen NN, Chen WD, Lai CH, Kuo CN, Chen CL, Huang JC, Wu PC, Wu PL, Chen CY. Optical Coherence Tomographic Patterns as Predictors of Structural Outcome After Intravitreal Ranibizumab in Diabetic Macula Edema. Clin Ophthalmol 2020; 14:4023-4030. [PMID: 33262567 PMCID: PMC7698720 DOI: 10.2147/opth.s264669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background/Objectives The purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT). Subjects/Methods This retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings. Results For a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007, <0.001, respectively). Conclusion A trend toward decreased effectiveness after long-term IVR treatment was observed in the DRT group. Consistent IVR treatment could still achieve favorable improvement in the reduction of CMT in 2-year follow-up in the VMIA group. Different OCT patterns in DME may affect the therapeutic role of anti-VEGF agents and predict the structure outcome.
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Affiliation(s)
- Nan-Ni Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Dar Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-Hsiung Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Neng Kuo
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Lung Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Optometry, Chung Hwa University of Medical Technology, Tainan City, Taiwan
| | - Jou-Chen Huang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Chen Wu
- Department of Ophthalmology, Landseed International Hospital, Taoyuan, Taiwan
| | - Pei-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chau-Yin Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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Bayat AH, Elçioğlu MN. Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema. Ther Adv Ophthalmol 2020; 12:2515841420971936. [PMID: 33225213 PMCID: PMC7658505 DOI: 10.1177/2515841420971936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME). Materials and methods Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment. Results There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months (p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months (p < 0.001). When groups were compared, the change in CRT was higher in the SRD group (p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes (p = 0.448). Conclusion The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME.
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Affiliation(s)
- Alper Halil Bayat
- Department of Ophthalmology, Esenler Hospital, Medipol University, Birlik mah. Bahçeler cad. No:5, Esenler, 34083 İstanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
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17
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Choovuthayakorn J, Phinyo P, Tantraworasin A, Kunavisarut P, Patikulsila D, Chaikitmongkol V, Watanachai N, Pathanapitoon K. Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Clinical Practice of Single Center: Three-Year Outcomes. Ophthalmic Res 2020; 64:483-493. [PMID: 33053556 DOI: 10.1159/000512300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to explore visual and anatomical outcomes in patients who underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for visual impairment from center-involved diabetic macular edema (CI-DME) in clinical practice. METHODS Medical records of consecutive CI-DME patients who initiated treatment with intravitreal bevacizumab injection between January 2012 and December 2016 and were followed for at least 12 months were retrospectively reviewed. Visual and anatomical changes after treatment over a 36-month period were evaluated. RESULTS There were 286 patients (423 eyes) with a mean (standard deviation, SD) age of 56.8 (8.5) years included in this study. One hundred and forty-six (51%) patients were female, and 137 (47.9%) patients received bilateral eye treatment. Mean (SD) presenting visual acuity (VA) of overall eyes was 50.2 (19.6) letter scores. Stratified by baseline vision, eyes with initial VA worse than 20/40 achieved a statistically significant VA improvement, compared to baseline, by +8.4, +6.9, and +5.4 letters at 12, 24, and 36 months, respectively, with all p values <0.001. However, when initial VA was 20/40 and better, a non-statistically significant change in mean VA by +2.0, -3.5, and -3.6 letters were noted at the same time point (p value between 0.078 and 0.273). Unlike visual changes, a statistically significant decline in central subfield thickness compared to baseline was noted at the end of months 12, 24, and 36 in both initial VA subgroups (all p values <0.001). Nevertheless, even though the median number of given injections considerably decreased from 6 in the first 12 months to 2 in the second 12-month period and 1 in the final 12-month interval, required ophthalmic clinic visits decreased in frequency with median numbers of 10, 7, and 6 appointments in each consecutive 12-month duration. CONCLUSION This study supports the benefits of practical intravitreal anti-VEGF utilization to manage CI-DME in real-world settings. The improvement of vision in eyes presenting with poor baseline VA and maintenance of vision in eyes with better baseline VA were demonstrated through the 3-year review of each case. However, the burden of frequent monitoring warrants further evaluation of long-term compliance and efficacy.
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Affiliation(s)
- Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Furino C, Niro A, Reibaldi M, Boscia F, Alessio G. Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema. J Ophthalmic Vis Res 2020; 15:524-530. [PMID: 33133444 PMCID: PMC7591829 DOI: 10.18502/jovr.v15i4.7787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/05/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Different patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD). METHODS In this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment. RESULTS There were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P < 0.01 and P ≤ 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, -149 ± 127 µm vs four-month CRT reduction, -72 ± 174 µm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, -0.49 ± 1.7 mm3 vs Group 2, -1.3 ± 1.3 mm3 ; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed. CONCLUSION DEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy.
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Affiliation(s)
- Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital “S. G. MOSCATI”, ASL TA, Taranto, Italy
| | | | - Francesco Boscia
- Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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19
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Chatziralli I, Theodossiadis G, Dimitriou E, Kazantzis D, Theodossiadis P. Association between the patterns of diabetic macular edema and photoreceptors' response after intravitreal ranibizumab treatment: a spectral-domain optical coherence tomography study. Int Ophthalmol 2020; 40:2441-2448. [PMID: 32424527 DOI: 10.1007/s10792-020-01423-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To analyze photoreceptors' condition after intravitreal ranibizumab treatment according to the pattern of diabetic macular edema (DME) on spectral-domain optical coherence tomography (SD-OCT). METHODS Retrospective study includes 58 treatment naïve patients with DME, treated with intravitreal ranibizumab injections and followed up for at least 12 months. Patients were classified based on DME morphology on SD-OCT into: diffuse macular edema, cystoid macular edema (CME) and serous retinal detachment with CME (SRD/CME). The DME morphology was analyzed, while quantitative measurement of ellipsoid zone (EZ) defect, as well as qualitative assessment of the condition of external limiting membrane (ELM) and interdigitation zone (IZ) at foveal area, was taken before and after treatment. RESULTS Before treatment, patients with CME presented worse ELM and IZ condition and greater EZ defect than patients with diffuse macular edema or SRD/CME. After treatment, the restoration of EZ defect and IZ was more evident in patients with CME than in diffuse macular edema or SRD/CME. CONCLUSION Patients with DME presented significant photoreceptors' restoration after intravitreal ranibizumab injections at the 12-month follow-up. The improvement in EZ defect size and IZ was dependent on the pattern of DME on SD-OCT.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
- Attikon University Hospital, 1, Rimini Street, 12462, Haidari, Greece.
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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20
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ASSOCIATION BETWEEN EARLY ANATOMIC RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY AND LONG-TERM OUTCOME IN DIABETIC MACULAR EDEMA: An Independent Analysis of Protocol i Study Data. Retina 2020; 39:88-97. [PMID: 29474302 PMCID: PMC6325771 DOI: 10.1097/iae.0000000000002110] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This retrospective analysis of Protocol I study data demonstrates a significant positive association between early (Week 12) retinal anatomical response and long-term (1- and 3-year) anatomical response with ranibizumab in center-involved diabetic macular edema. By contrast, early anatomical response was not significantly associated with long-term visual acuity response. Purpose: This post hoc analysis explores the relationship between early retinal anatomical response and long-term anatomical and visual outcomes with ranibizumab in center-involved diabetic macular edema. Methods: Eyes randomized to the ranibizumab plus prompt laser and ranibizumab plus deferred laser treatment arms in the Protocol I study were categorized according to their proportional reduction (<20 vs. ≥20%) in central retinal thickness (CRT) after 12 weeks. Adjusted and unadjusted analyses assessed the association between early (Week 12) anatomical response and long-term (Weeks 52 and 156) anatomical and best-corrected visual acuity outcomes. Results: Of 335 study eyes, 118 showed limited (<20%) and 217 showed strong (≥20%) CRT reduction at Week 12. In unadjusted and adjusted analyses, limited early CRT response was negatively and significantly associated with strong CRT response at Weeks 52 and 156. Sensitivity analyses indicated that this association was robust and unrelated to any “floor effect.” In unadjusted analyses, a strong early CRT response was associated with greater long-term improvement in best-corrected visual acuity; after controlling for confounders, the association lost statistical significance. Conclusion: Early CRT response to ranibizumab is a significant prognostic indicator of medium- to long-term anatomical outcome in center-involved diabetic macular edema.
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21
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Jian G, Jing XY, Yang L, Lun L. Quantitative Analysis of Foveal Microvascular Differences in Diabetic Macular Edema with and without Subfoveal Neuroretinal Detachment. J Diabetes Res 2020; 2020:2582690. [PMID: 32185235 PMCID: PMC7063210 DOI: 10.1155/2020/2582690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study is aimed at quantifying the difference of the foveal microvasculature in the eyes with diabetic macular edema (DME) with and without subfoveal neuroretinal detachment (SND+ and SND-, respectively). METHODS This retrospective, cross-sectional study included 48 eyes from 42 patients with DME (20 SND+ and 28 SND- eyes). Data collection included fundus color photographs, optical coherence tomography angiography (OCTA), and best-corrected visual acuity. The following parameters were evaluated with OCTA: foveal avascular zone (FAZ) parameters and vessel density in a width of 300 μm around the FAZ, superficial capillary plexus, deep capillary plexus (DCP), and choriocapillary plexus. The number of retinal hyperreflective spots (HRS) and the area of SND in the central 3 mm were evaluated at 0 degrees using B-scans. RESULTS Parafoveal vessel densities of DCP were significantly lower in SND+ than in SND- eyes (p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (r = 0.389, p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (. CONCLUSION DME with SND correlated with larger numbers of HRS and significant macular microvascular impairment in the DCP. The pathophysiology of decline of parafoveal vessel density in the DCP with an increase in the number of HRS in the eyes with DME with SND needs further investigation.
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Affiliation(s)
- Gao Jian
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xu Ya Jing
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li Yang
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Liu Lun
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Ozdemir MH, Elbay A, Kirik F, Ekinci C, Koytak A. Regression of Serous Macular Detachment After Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema. J Ocul Pharmacol Ther 2019; 35:558-564. [DOI: 10.1089/jop.2019.0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Mehmet Hakan Ozdemir
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Elbay
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Furkan Kirik
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Cansu Ekinci
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Bezzina AD, Carbonaro F. Factors Predicting Treatment Response in Anti-Vascular Endothelial Growth Factor Naïve Diabetic Macular Edema Patients Treated with Intravitreal Bevacizumab. J Ocul Pharmacol Ther 2019; 35:551-557. [PMID: 31603371 DOI: 10.1089/jop.2018.0112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To identify factors that affect the therapeutic response of intravitreal bevacizumab in diabetic macular edema (DMO) and explore the correlation between the functional and anatomical outcomes observed. Methods: A retrospective, noncomparative, consecutive case series design was used. Baseline imaging data and clinical records of 65 eyes with DMO, secondary to type II diabetes mellitus, which received intravitreal bevacizumab for the first time in 2016, were analyzed. The central macular thickness (CMT), macular volume, and best-corrected visual acuity (BCVA), following the initial 3 injection loading phase were recorded. Outcomes were compared to multiple variables including glycemic control, diabetic retinopathy grade, DMO subtype on optical coherence tomography, and use of past macular laser therapy. Results: The participants' age ranged from 46 to 84 of which 63% were men and 37% were women. The mean baseline CMT was 443.21 μm. A mean reduction of 11.23% (P < 0.0005) in CMT was observed following the loading phase. Women exhibited a greater reduction in CMT (P = 0.032). Participants with diffuse retinal thickening (DRT) and with cystoid macular edema (CMO) showed a net reduction in CMT of 17.39% (P = 0.047) and 8.24% (P = 0.04) respectively. Eyes with proliferative diabetic retinopathy demonstrated a mean gain in CMT of 16.86% (P = 0.001). Conclusions: Female patients and DRT demonstrated a positive anatomical response. Patients with CMO and proliferative diabetic retinopathy displayed a negative therapeutic response. Such observations may be considered in clinical decision-making when opting for anti-vascular endothelial growth factor (VEGF) therapy for DMO.
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Affiliation(s)
- Alastair David Bezzina
- Specialist Research Project submitted in partial fulfillment of the requirements for the qualification of Master in Surgery (Ch.M.) in Clinical Ophthalmology offered by the University of Edinburgh.,Department of Ophthalmology, Mater Dei General Hospital, Msida, Malta
| | - Francis Carbonaro
- Specialist Research Project submitted in partial fulfillment of the requirements for the qualification of Master in Surgery (Ch.M.) in Clinical Ophthalmology offered by the University of Edinburgh.,Department of Ophthalmology, Mater Dei General Hospital, Msida, Malta
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Relationship between duration and extent of oedema and visual acuity outcome with ranibizumab in diabetic macular oedema: A post hoc analysis of Protocol I data. Eye (Lond) 2019; 34:480-490. [PMID: 31320738 PMCID: PMC7042302 DOI: 10.1038/s41433-019-0522-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 05/25/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES This post hoc analysis explores the relationship between residual oedema exposure after ranibizumab treatment initiation and long-term visual acuity outcome in eyes with centre-involved diabetic macular oedema (DMO). SUBJECTS/METHODS Eyes randomised to the ranibizumab + prompt or deferred laser treatment arms in the Protocol I trial and with observed central retinal thickness (CRT) readings at baseline and ≥1 follow-up visits (n = 367) were stratified by 1) oedema duration (number of study visits with CRT ≥ 250 µm during the first 52 weeks of ranibizumab treatment); and 2) oedema extent (amount of excess CRT [≥ 250 µm] at each study visit, averaged over the first 52 weeks). Associations between measures of residual oedema and best-corrected visual acuity (BCVA) were assessed in multiple regression analyses. RESULTS Oedema duration and oedema extent during the first 52 weeks of ranibizumab treatment showed significant negative associations with BCVA improvement at weeks 52, 104 and 156. Eyes with the most persistent oedema gained (mean) 4.4 (95% CI 0.1─8.7) fewer Early Treatment Diabetic Retinopathy Study (ETDRS) letters at week 156 than eyes with the least persistent oedema (P = 0.044). Eyes with the greatest amount of oedema gained (mean) 9.3 (95% CI 4.0─14.5) fewer ETDRS letters at week 156 than eyes with the least amount of oedema (P < 0.001). CONCLUSIONS Macular oedema exposure over the first 52 weeks of ranibizumab treatment is a negative prognostic factor for long-term visual acuity improvement in centre-involved DMO.
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Lee YJ, Kim M. Macular Hole Formation after Intravitreal Injection of Bevacizumab for Diabetic Macular Edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:198-199. [PMID: 30977331 PMCID: PMC6462477 DOI: 10.3341/kjo.2018.0079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yun Ji Lee
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Moosang Kim
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea.
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26
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Castro-Navarro V, Cervera-Taulet E, Navarro-Palop C, Hernández-Bel L, Monferrer-Adsuara C, Mata-Moret L, Montero-Hernández J. Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant. Eur J Ophthalmol 2019; 30:764-769. [DOI: 10.1177/1120672119834182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. Methods: Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. Results: In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p < 0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). Conclusion: Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months.
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Affiliation(s)
| | | | | | | | | | - Lucía Mata-Moret
- Consorci Hospital General Universitari de Valencia, Valencia, Spain
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Lee H, Kang KE, Chung H, Kim HC. Three-dimensional analysis of morphologic changes and visual outcomes in diabetic macular edema. Jpn J Ophthalmol 2019; 63:234-242. [PMID: 30783942 DOI: 10.1007/s10384-019-00657-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the association of retinal fluid volume with the visual and anatomic outcomes of patients with diabetic macular edema (DME) after treatment with bevacizumab. STUDY DESIGN Retrospective observational study. METHODS We retrospectively analyzed 65 eyes of 58 DME patients treated with bevacizumab. The volumes of the inner intraretinal fluid (IRF) in the inner nuclear layer (INL), outer IRF in the outer plexiform layer (OPL)/outer nuclear layer (ONL), and subretinal fluid (SRF) were calculated. The correlations between the baseline fluid volumes and best-corrected visual acuity (BCVA), area of disorganization of the retinal inner layers (DRIL), disrupted external limiting membrane (ELM), and disrupted ellipsoid zone (EZ) at 12 months after treatment were assessed. RESULTS The baseline volume of the inner IRF correlated with poor BCVA at the final visit (r = 0.52, P < .001) whereas the baseline volume of the outer IRF and SRF volume did not show a significant correlation with BCVA at the final visit (P = .07 and P = .61, respectively). The improvement in BCVA correlated with the reduction in the baseline volume of the inner IRF and outer IRF (r = 0.25, P = .04 and r = 0.36, P = .003), but not with the SRF volume (P = .59). The baseline volume of the inner IRF correlated positively with the area of DRIL and the disrupted ELM at the final visit (r = 0.56, P < .001 and r = 0.25, P = .04, respectively). Such relationship remained in each quadrant of the macula (P < .005 for all quadrants). CONCLUSION The baseline volume of the inner IRF correlated with a poor visual outcome, an increased DRIL area, and a more disrupted ELM area in patients with DME after treatment with bevacizumab.
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Affiliation(s)
- Hyungwoo Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Kyung Eun Kang
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hyewon Chung
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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Chung YR, Kim YH, Ha SJ, Byeon HE, Cho CH, Kim JH, Lee K. Role of Inflammation in Classification of Diabetic Macular Edema by Optical Coherence Tomography. J Diabetes Res 2019; 2019:8164250. [PMID: 31930145 PMCID: PMC6939426 DOI: 10.1155/2019/8164250] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/30/2019] [Indexed: 12/22/2022] Open
Abstract
Diabetic macular edema (DME) is the abnormal accumulation of fluid in the subretinal or intraretinal spaces in the macula in patients with diabetic retinopathy and leads to severely impaired central vision. Technical developments in retinal imaging systems have led to many advances in the study of DME. In particular, optical coherence tomography (OCT) can provide longitudinal and microstructural analysis of the macula. A comprehensive review was provided regarding the role of inflammation using OCT-based classification of DME and current and ongoing therapeutic approaches. In this review, we first describe the pathogenesis of DME, then discuss the classification of DME based on OCT findings and the association of different types of DME with inflammation, and finally describe current and ongoing therapeutic approaches using OCT-based classification of DME. Inflammation has an important role in the pathogenesis of DME, but its role appears to differ among the DME phenotypes, as determined by OCT. It is important to determine how the different DME subtypes respond to intravitreal injections of steroids, antivascular endothelial growth factor agents, and other drugs to improve prognosis and responsiveness to treatment.
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Affiliation(s)
- Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Ho Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Jung Ha
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hye-Eun Byeon
- Institute of Medical Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chung-Hyun Cho
- Vascular Microenvironment Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hun Kim
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
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Factors Influencing Intravitreal Bevacizumab and Triamcinolone Treatment in Patients with Diabetic Macular Edema. Eur J Ophthalmol 2018; 27:746-750. [PMID: 28430331 DOI: 10.5301/ejo.5000974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate factors associated with response to intravitreal bevacizumab (IVB) and intravitreal triamcinolone acetonide (IVTA) in diabetic macular edema (DME). METHODS Ninety-one eyes of 88 patients diagnosed with DME were enrolled in this retrospective chart review. Group 1 included eyes that showed good response to IVB. Group 2 included eyes that did not respond to IVB but responded to IVTA. Group 3 included eyes that responded to neither. Clinical factors, HbA1c, and optical coherence tomography (OCT) findings including patterns of macular edema were compared among the 3 groups. RESULTS A total of 44, 27, and 20 eyes were included in groups 1, 2, and 3, respectively. HbA1c was higher in group 3 than in the other groups. Proportion of full (combination of all patterns) type edema was higher in group 3 than in the other 2 groups. In group 1, the proportion of sponge-like diffuse retinal thickening type was higher and cystoid macular edema type was lower than in the other groups. CONCLUSIONS The degree of diabetic control and morphologic subtypes with OCT should be considered to better predict the prognosis after treatment in DME.
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Kaya M, Karahan E, Ozturk T, Kocak N, Kaynak S. Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema with Serous Retinal Detachment. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:296-302. [PMID: 30091308 PMCID: PMC6085191 DOI: 10.3341/kjo.2017.0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/20/2017] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mahmut Kaya
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - Eyyup Karahan
- Department of Ophthalmology, Van Training and Research Hospital, Van, Turkey
| | - Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nilufer Kocak
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Suleyman Kaynak
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Demircan A, Ozkaya A, Alkin Z, Kemer B, Yesilkaya C, Demir G. Comparison of the effect of ranibizumab and dexamethasone implant on serous retinal detachment in diabetic macular edema. J Fr Ophtalmol 2018; 41:733-738. [PMID: 30213609 DOI: 10.1016/j.jfo.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) on neurosensory retinal detachment (SRD) associated with diabetic macular edema (DME) in the early treatment period. METHODS This was a retrospective, interventional, case-control study. After three monthly loading doses of IVR or an initial IDI injection, the changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) on OCT, and presence and height of SRD were evaluated. RESULTS The IVR and IDI groups consisted of 101 and 35 eyes, respectively. The mean changes in CMT in the IVR and IDI groups were 204.4±176.6 and 311.4±163, respectively (P<0.001). The mean changes in SRD height in the IVR and IDI groups were 133.6±92.1 and 168.6±103.9μm, respectively. The decrease in SRD height was significantly greater in the IDI group than in the IVR group (P=0.002). The SRD resolved completely in 72.2% and 71.4% of the patients in the IVR and IDI groups, respectively (P=0.9). CONCLUSION The mean reduction in CMT and SRD height was greater in the IDI group than in the IVR group. There was a negative correlation between baseline best-corrected visual acuity (BCVA) and SRD height and also between BCVA and CMT.
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Affiliation(s)
- A Demircan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey.
| | - A Ozkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - Z Alkin
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - B Kemer
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - C Yesilkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - G Demir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
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Acan D, Karahan E, Kocak N, Kaynak S. Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema. Int J Ophthalmol 2018; 11:1204-1209. [PMID: 30046540 DOI: 10.18240/ijo.2018.07.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/26/2017] [Indexed: 12/22/2022] Open
Abstract
AIM To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT). METHODS In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.
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Affiliation(s)
- Durgul Acan
- Department of Ophthalmology, Yatagan Public Hospital, Mugla 48500, Turkey
| | - Eyyup Karahan
- Department of Ophthalmology, Van Training and Research Hospital, Van 65300, Turkey
| | - Nilufer Kocak
- Department of Ophthalmology, Dokuz Eylul University Faculty of Medicine, Izmir 35330, Turkey
| | - Suleyman Kaynak
- Department of Ophthalmology, Dokuz Eylul University Faculty of Medicine, Izmir 35330, Turkey
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INTRAVITREAL DEXAMETHASONE IMPLANTATION IN PATIENTS WITH DIFFERENT MORPHOLOGICAL DIABETIC MACULAR EDEMA HAVING INSUFFICIENT RESPONSE TO RANIBIZUMAB. Retina 2018; 38:986-992. [PMID: 28426623 DOI: 10.1097/iae.0000000000001648] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types. METHODS In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12). Primary outcome measures were best corrected visual acuity, and central macular thickness. RESULTS The three subgroups were similar in terms of age and gender (P > 0.05). Total duration of diabetes was significantly less in the serous retinal detachment subgroup (P = 0.01). There were no differences in the best corrected visual acuity between the three subgroups until the sixth month. However, the best corrected visual acuity was significantly better in the diffuse retinal thickness subgroup at the sixth month (P = 0.008). Regarding the central macular thickness values, it was statistically better in serous retinal detachment than in diffuse retinal thickening and cystoid macular edema subgroups till the sixth month (P = 0.001). However, at the sixth month, there was not any statistical difference between subgroups regarding central macular thickness values. Antiglaucomatous agents were required in 4 (11.4%) patients throughout the study. CONCLUSION Treatment algorithms should differ according to the morphology of diabetic macular edema; however, more data is needed to give specific recommendations.
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Ercalik NY, Imamoglu S, Turkseven Kumral E, Yenerel NM, Bardak H, Bardak Y. Influence of serous retinal detachment on the outcome of ranibizumab treatment in diabetic macular oedema. Cutan Ocul Toxicol 2018; 37:324-327. [PMID: 29619858 DOI: 10.1080/15569527.2018.1459667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of serous retinal detachment (SRD) on the outcome of intravitreal ranibizumab (IVR) therapy in diabetic macular oedema (DME). MATERIALS AND METHODS Fifty-one eyes with cystoid macular oedema (CME) and SRD (study group) and 57 eyes with only CME (control group) that received pro re nata (PRN) IVR injections during a 6-month period were retrospectively evaluated. The outcome measures included changes in the central macular thickness (CMT) and best corrected visual acuity (BCVA) and injection numbers. RESULTS The mean initial CMT in the study and control groups was 467 ± 101 and 440 ± 89 µm, respectively. The mean BCVA in the study and control groups was 0.75 ± 0.38 and 0.59 ± 0.36 logarithm of minimal angle of resolution (LogMAR), respectively (p = 0.010). The study group received a mean of 2.2 ± 0.92 injections, whereas the control group received a mean of 2.54 ± 0.9 injections. The decrease in CMT was greater, but not significantly greater, in the study group than in the control group. CONCLUSION The presence of SRD resulted in a less favourable visual acuity (VA) outcome with IVR. Disruption of the ellipsoid zone and abnormality of the foveal avascular zone at the baseline examination were correlated with a lower VA. Both of the pathologies occurred more frequently in the SRD group.
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Affiliation(s)
- Nimet Yesim Ercalik
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Serhat Imamoglu
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Esra Turkseven Kumral
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Nursal Melda Yenerel
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Handan Bardak
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Yavuz Bardak
- a Department of Ophthalmology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
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Murakami T, Suzuma K, Uji A, Yoshitake S, Dodo Y, Fujimoto M, Yoshitake T, Miwa Y, Yoshimura N. Association between characteristics of foveal cystoid spaces and short-term responsiveness to ranibizumab for diabetic macular edema. Jpn J Ophthalmol 2018; 62:292-301. [PMID: 29460019 DOI: 10.1007/s10384-018-0575-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the association between the characteristics of foveal cystoid spaces and short-term responsiveness to ranibizumab treatment for diabetic macular edema (DME) at 3 months from the initial injection. METHODS We retrospectively reviewed 66 eyes of 61 patients with center-involved DME who received three consecutive ranibizumab injections and following as-needed administrations. We evaluated the relationship between visual improvement at 3 months and the preoperative optical coherence tomography (OCT) parameters including hyperreflective foci, heterogeneous OCT reflectivity, mean levels of OCT reflectivity and height of foveal cystoid spaces. RESULTS Twenty-three eyes without preoperative hyperreflective foci in the foveal cystoid spaces had significantly greater improvement in the logarithm of the minimum angle of resolution visual acuity (logMAR VA) at 3 months than 43 eyes with foci (P = 0.006). That was similar to the greater reduction in CSF thickness in eyes without lesions after treatment at the same time point (P < 0.001). VA improvement at 3 months was not associated with the height (R = 0.215, P = 0.083) or the reflectivity levels (R = -0.079, P = 0.538) of foveal cystoid spaces. There were no differences in VA changes between eyes with and without heterogeneous reflectivity in foveal cystoid spaces (P = 0.297). Multivariate analyses showed that logMAR VA and the absence of hyperreflective foci in foveal cystoid spaces were associated with VA improvement at 3 months. CONCLUSION Hyperreflective foci in foveal cystoid spaces at baseline predict poorer short-term responsiveness to ranibizumab injections for DME.
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Affiliation(s)
- Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan.
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Tatsuya Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Yuko Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
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Elbay A, Ozdemir H, Koytak A, Melikov A. Intravitreal Dexamethasone Implant for Treatment of Serous Macular Detachment in Central Retinal Vein Occlusion. J Ocul Pharmacol Ther 2017; 33:473-479. [DOI: 10.1089/jop.2016.0187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmet Elbay
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hakan Ozdemir
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Melikov
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Shiraya T, Kato S, Araki F, Ueta T, Miyaji T, Yamaguchi T. Aqueous cytokine levels are associated with reduced macular thickness after intravitreal ranibizumab for diabetic macular edema. PLoS One 2017; 12:e0174340. [PMID: 28346545 PMCID: PMC5367773 DOI: 10.1371/journal.pone.0174340] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/07/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose It is controversial whether the administration of anti-vascular endothelial growth factor drugs for diabetic macular edema (DME) affects intraocular inflammatory cytokines. In this study, we measured cytokine concentration in aqueous humor before and after intravitreal injection of ranibizumab (IVR). The aim was to determine changes in cytokine concentration and their effects on DME reduction. Methods Twelve patients (13 eyes) with DME received two IVR (0.5 mg) with a 1 month interval, and a total of 26 aqueous humor samples were obtained. Macular thickness was measured with an optical coherence tomography (OCT) using thickness-map mode with an Early Treatment Diabetic Retinopathy Study (ETDRS) 9-zone grid that was divided into two zones: a central circle with a diameter of 1 mm (zone1); and an outer circle with a diameter of 6 mm (zone2). Results The concentration of eotaxin-1 in aqueous humor samples decreased significantly after IVR. Baseline cytokine concentration was associated with IVR-induced DME reduction. In zone1, higher baseline concentration of interferon-induced protein (IP)-10, and in zone 2, higher baseline concentration of granulocyte-macrophage colony-stimulating factor, IP-10, and tumor necrosis factor (TNF) α; and lower baseline concentration of eotaxin-1, interleukin (IL)-5, and IL-8 were associated with improved DME. Cytokine changes were associated with IVR-induced DME reduction. In zone1, lower concentration of IP-10 compared to baseline or higher concentration of macrophage inflammatory protein (MIP) -α, and in zone 2, lower concentration of IL-5 compared to baseline, IL-8, and IP-10 or higher concentration of eotaxin-1 and MIP-1β were associated with improved DME. Conclusions These findings suggest that ranibizumab affects the concentration of cytokines in aqueous humor. Various cytokines contribute to a decrease in retinal thickness, both in the center of the macula and in a larger area of the retina.
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Affiliation(s)
- Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Satoshi Kato
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bandyopadhyay S, Bandyopadhyay SK, Saha M, Sinha A. Study of aqueous cytokines in patients with different patterns of diabetic macular edema based on optical coherence tomography. Int Ophthalmol 2017; 38:241-249. [DOI: 10.1007/s10792-017-0453-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/19/2017] [Indexed: 01/17/2023]
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Kim M, Kim Y, Lee SJ. Comparison of aqueous concentrations of angiogenic and inflammatory cytokines based on optical coherence tomography patterns of diabetic macular edema. Indian J Ophthalmol 2016; 63:312-7. [PMID: 26044469 PMCID: PMC4463554 DOI: 10.4103/0301-4738.158069] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: The purpose was to compare aqueous inflammatory and angiogenic cytokine levels in diabetic macular edema (DME). Materials and Methods: Aqueous samples were obtained from 50 eyes with DME and 12 normal eyes (control group). DME was classified according to the morphologic pattern based on optical coherence tomography: Diffuse retinal thickening (DRT; n = 19), cystoid macular edema (CME; n = 17), or serous retinal detachment (SRD; n = 14). Aqueous samples were collected just before intravitreal injection and at the beginning of cataract surgery in the control group. Interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) levels were measured by multiplex bead assay. Results: The IL-6, IL-8, IP-10, and PDGF-AA levels differed significantly among the three groups of DME (P = 0.014, P = 0.038, P = 0.021, and P = 0.041, respectively). However, there were no differences between groups in aqueous concentration levels of MCP-1 and VEGF (P = 0.205 and P = 0.062, respectively). IL-6 (P = 0.026) and IL-8 (P = 0.023) correlated positively with central foveal thickness (CFT) in the CME group. None of the cytokine levels correlated significantly with CFT in any of the DRT and SRD groups. Conclusions: Aqueous concentrations of cytokines varied according to the morphologic pattern of DME, which might explain the variable response to treatments such as intravitreal bevacizumab or triamcinolone injection.
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Affiliation(s)
| | | | - Seung-Jun Lee
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea
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VISUAL AND MORPHOLOGIC OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR DIABETIC MACULAR EDEMA BASED ON OPTICAL COHERENCE TOMOGRAPHY PATTERNS. Retina 2016; 36:588-95. [PMID: 26398695 DOI: 10.1097/iae.0000000000000770] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the visual and morphologic outcomes of intravitreal ranibizumab (IVR) in eyes with diabetic macular edema (DME) based on the morphologic pattern on optical coherence tomography. METHODS A prospective and consecutive series of 55 eyes with DME was classified according to OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Patients received three consecutive monthly injections of IVR and as needed thereafter. The primary outcome was the number of treatments undertaken by DME type over 12 months. Best-corrected visual acuity, retinal thickness, and microstructural changes were also evaluated. RESULTS The eyes were classified as DRT (n = 23), CME (16), or SRD (16). The mean number of injections over 12 months was significantly different among the groups: DRT (3.69), CME (5.33), and SRD (5.09; P = 0.028). Best-corrected visual acuity of SRD (20/60) was significantly worse than that of the other types (DRT = 20/38; CME = 20/43; P = 0.015) after 12 months. CONCLUSION Vision gains and retinal anatomy improvement were maintained in all three types during the first year of IVR administration. Especially, DRT maintained a good response to ranibizumab in a fewer number of injections. Disruption of the photoreceptor integrity at the baseline was correlated with poorer visual outcome and occurred more frequently in SRD.
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CORRELATION OF OPTICAL COHERENCE TOMOGRAPHIC HYPERREFLECTIVE FOCI WITH VISUAL OUTCOMES IN DIFFERENT PATTERNS OF DIABETIC MACULAR EDEMA. Retina 2016; 36:1630-9. [DOI: 10.1097/iae.0000000000000995] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ercalik NY, Yenerel NM, Imamoglu S, Kumral ET, Vural ET. Combined Intravitreal Ranibizumab and Sub-Tenon Injection of Triamcinolone for the Treatment of Diabetic Macular Edema with Retinal Detachment. J Ocul Pharmacol Ther 2016; 32:225-9. [PMID: 27092435 DOI: 10.1089/jop.2015.0092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal ranibizumab (IVR) combined with posterior sub-Tenon injection of triamcinolone acetonide (STTA) for treatment of diabetic macular edema (DME) with serous retinal detachment (SRD). METHODS Eighty-five eyes of 65 patients with DME and SRD were enrolled in this retrospective study. Fifty-eight eyes were treated with IVR and STTA (combined group), whereas 27 eyes were treated with pro re nata (PRN) IVR (control group). The combined group patients received a single and the control group patients received mean 1.29 ± 0.46 injections and followed for 3 months. The primary outcome measures were change in central macular thickness (CMT) and best corrected visual acuity (BCVA). The secondary outcome measure was the complication rate. RESULTS In the combined group, mean initial CMT was 543.9 ± 133.5 μm. Macular thickness was significantly reduced both after 1 month (334 ± 88 μm; P < 0.001) and after 3 months (387.6 ± 131.9 μm; P < 0.001) of treatment. At the 3-month follow-up, BCVA improved in 37.2% of the eyes. Complications were drug reflux at the time of STTA injection, elevation of intraocular pressure, and migration of hard exudates to the fovea. The decrease in CMT was statistically significant in the combined group in the first month, but not in the third month compared with the control group. The improvement in BCVA was not statistically significant between the 2 groups both after the first and third months. SRD disappeared with a higher rate with the combined therapy in the first month. CONCLUSION IVR and STTA seem to be effective in improving BCVA in DME with SRD.
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Affiliation(s)
| | | | - Serhat Imamoglu
- Haydarpaşa Numune Research and Training Hospital , Istanbul, Turkey
| | | | - Ece Turan Vural
- Haydarpaşa Numune Research and Training Hospital , Istanbul, Turkey
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Kim Y, Yu SY, Kwak HW. En Face Spectral-Domain Optical Coherence Tomography Imaging of Outer Retinal Hard Exudates in Diabetic Macular Edema Based on Optical Coherence Tomography Patterns. Ophthalmic Surg Lasers Imaging Retina 2016; 47:313-21. [PMID: 27065369 DOI: 10.3928/23258160-20160324-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/19/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate en face spectral-domain optical coherence tomography (SD-OCT) findings of the outer retinal hard exudates in diabetic macular edema (DME). PATIENTS AND METHODS Exploratory analyses of prospective and consecutive case series. Fifty-five eyes treated with intravitreal ranibizumab (IVR) (Lucentis; Genentech, South San Francisco, CA) for 12 months were classified according to OCT features of DME: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Area fraction of outer nuclear layer (ONL) hard exudates (HEs) was assessed from en face OCT images. RESULTS Area fraction of ONL HEs increased from 1.45% ± 1.22% to 2.24% ± 1.31% in DRT and from 2.24% ± 1.85% to 3.25% ± 1.52% in CME. HE gain was greatest during first 3 months (DRT = 0.83%; CME = 1.25%). SRD showed no difference in HEs (P = .462). CONCLUSIONS ONL HEs increased in DRT and CME at month 12 following IVR. Rapid gain of HEs was found during the initial loading phase of IVR.
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Kim MW, Moon H, Yang SJ, Joe SG. Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:25-31. [PMID: 26865800 PMCID: PMC4742642 DOI: 10.3341/kjo.2016.30.1.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/27/2015] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure. Methods Patients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography. Results Forty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected. Conclusions Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.
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Affiliation(s)
- Min Woo Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Haein Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Jae Yang
- Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Soo Geun Joe
- Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Kim K, Kim ES, Kwak HW, Yu SY. Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.10.1604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kiyoung Kim
- Division of Ophthalmology, Department of Medicine, Kyung Hee University Graduate School, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Woo Kwak
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Osman Saatci A, Ayhan Z, Durmaz Engin C. Simultaneous Intravitreal Ranibizumab and Dexamethasone Implant Administration at the Same Setting in Eyes with Severe Diabetic Macular Edema. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojoph.2016.62016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lee JH, Chung HY, Lee KM, Park YS, Sohn JH, Hwang DJ. Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Functional outcome of macular edema in different retinal disorders. Prog Retin Eye Res 2015; 48:119-36. [DOI: 10.1016/j.preteyeres.2015.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 12/11/2022]
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Comparison of intravitreal triamcinolone acetonide versus intravitreal bevacizumab as the primary treatment of clinically significant macular edema. Retina 2015; 35:272-9. [PMID: 25105313 DOI: 10.1097/iae.0000000000000300] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the short-term efficacy of triamcinolone acetonide versus bevacizumab for the treatment of diabetic, clinically significant, macular edema with different optical coherence tomography findings. METHODS Fifty eyes of 45 consecutive patients with diabetic, clinically significant, macular edema were incorporated in this prospective interventional case series. Patients were divided into 3 groups according to findings on optical coherence tomography: 1) macular edema combined with serous retinal detachment (Group 1), 2) diffused macular thickening (Group 2), and 3) cystoid macular edema (Group 3). Patients from each group were treated with a single intravitreal injection of triamcinolone (IVTA) or 2 intravitreal injections of bevacizumab (IVB) with an interval of 6 weeks. Patients were observed at 6, 12, and 24 weeks after IVTA or the first IVB injection. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were examined at each visit. Repeated-measures analysis of variance was used to compare the efficacy of the treatment groups. RESULTS In Group 1, IVTA showed more favorable effects on CRT reduction and BCVA improvement compared with IVB at 6, 12, and 24 weeks (P = 0.002, 0.001, 0.027 and P = 0.036, 0.001, 0.027), respectively. In Group 2, IVB had more CRT reduction than IVTA at 6 and 12 weeks (P = 0.013 and 0.036), although there was no significant difference in BCVA improvement between the 2 groups (P > 0.05). In Group 3, IVTA and IVB did not have significant effects on CRT reduction and BCVA improvement (P > 0.05). CONCLUSION The short-term efficacy of IVTA and IVB on treating clinically significant macular edema varied with different optical coherence tomography findings. In clinically significant macular edema combined with serous retinal detachment, IVTA may be more favorable than IVB in CRT reduction and BCVA improvement. In patients with diffused macular thickening, IVB may be better than IVTA in macular thickness reduction, although this does not translate to a significant improvement in BCVA.
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Spectral domain optical coherence tomography predictors of visual outcome in diabetic cystoid macular edema after bevacizumab injection. Retina 2015; 34:1208-15. [PMID: 24368308 DOI: 10.1097/iae.0000000000000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To study prognostic spectral domain optical coherence tomography parameters in diabetic cystoid macular edema after anti-vascular endothelial growth factor therapy. METHODS Retrospective cohort study included 49 eyes with the new onset diabetic cystoid macular edema that had to have a macular spectral domain optical coherence tomography and fluorescein angiography at presentation. The baseline optical coherence tomography scans were analyzed for variables indicative of the extent of retinal involvement by the cystoid change and its location about the center. Univariate and multivariate analyses were performed comparing the optical coherence tomography findings between the two groups of eyes: the "No improvement" and the "Improvement" groups, based on at least two Snellen lines improvement after treatment. RESULTS There were 30 and 19 eyes in the No improvement and Improvement groups, respectively. In the univariate analysis, the baseline optical coherence tomography parameters associated with visual improvement included the photoreceptor inner segments thickness centrally (P = 0.009) and within the central 1-mm subfield (P < 0.0001), and the presence of bridging retinal processes centrally (P = 0.004). Multivariate analysis showed both presence and central location of bridging retinal processes within the central 1-mm subfield to be significantly associated with visual improvement (P = 0.041 and 0.005, respectively), with an odds ratio of 13.4 (95% confidence interval, 1.336-636.18; P = 0.010) for their central location. CONCLUSION In diabetic cystoid macular edema, visual improvement after anti-vascular endothelial growth factor therapy is more likely to occur in eyes with residual central retinal processes on baseline macular spectral domain optical coherence tomography. This finding may be helpful in patient counseling, case selection, and clinical trial planning.
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