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Morphological changes of foveal cysts as a predictor for visual response to anti-vascular endothelial growth factor treatments in diabetic macular edema

Degenerative cyst in DME

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Abstract

Purpose

To investigate morphological changes of intraretinal cyst in association with visual acuity following treatment for diabetic macular edema.

Methods

This retrospective study enrolled 105 eyes from 105 treatment naïve patients with diabetic macular edema following anti-vascular endothelial growth factor injections. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline, 1, 3, 6, and 12 months. The width and height of the largest intraretinal cyst (IRC) at all different visits were measured and were correlated to final visual acuity by receiver operating characteristic curve. The exudative feature was defined by the presence of hard exudates. Multivariate logistic regression was used to select the independent predictor for visual outcomes.

Results

Intraretinal cyst width but not the cyst height after treatment at 1 month independently predicted final visual loss of ten letters or more (multivariate P = 0.009). The optimal cutoff value was 196 um with a sensitivity of 0.889 and a specificity of 0.656. Eyes with large IRC width using this cutoff were consistently larger than those with small IRC width through 12 months (P = 0.008, Mann–Whitney U test). Small IRC width < 196 um at 1 month was more likely to coexist with exudative feature (P = 0.011, Fisher’s exact test). Among baseline factors, large IRC width predicted IRC width ≥ 196 um at 1 month (multivariate P < 0.001).

Conclusion

Cyst morphology following intravitreal injection predicts visual outcomes. Eyes with IRC width ≥ 196 um after treatment at 1 month tends to be more degenerative, and less likely to coexist with exudative feature.

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Acknowledgements

The authors declare that they do not receive any Grant or have any source of funding for this work.

Funding

The authors do not receive any Grant or have any source of funding for this work, and the authors declare that they have no conflict of interest or any financial disclosure related to this work.

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Authors and Affiliations

  1. Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan

    Meng-Ju Tsai

  2. Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, No 95, Wen-chang Road, Shih-lin District, Taipei, Taiwan

    Meng-Ju Tsai & Cheng-Kuo Cheng

  3. Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan

    Cheng-Kuo Cheng

  4. School of Medicine, National Taiwan University, Taipei, Taiwan

    Cheng-Kuo Cheng

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Contributions

MJT wrote the texts in the manuscript including introduction, material and methods, results and discussions, and also prepared the tables and figures. CK Cheng provided concept of this study, statistical analysis and critical revision of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Cheng-Kuo Cheng.

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Supplementary Information

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10792_2023_2674_MOESM1_ESM.tiff

Supplementary Figure 1. Analysis of time to resolution of subretinal fluid (A), and time to recurrence or occurrence of new subretinal fluid (B), based on the exudative status at baseline. (TIFF 1665 KB)

10792_2023_2674_MOESM2_ESM.tiff

Supplementary Figure 2. Analysis of time to resolution of subretinal fluid (A), and time to recurrence or occurrence of new subretinal fluid (B), based on the cyst size at 1 month. (TIFF 1522 KB)

10792_2023_2674_MOESM3_ESM.tiff

Supplementary Figure 3. The number of injections at different intervals over the course of follow-up (A), and distribution of eyes according to various number of injections (B), based on the cyst size at 1 month. (TIFF 1719 KB)

Supplementary file4 (DOCX 18 KB)

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Tsai, MJ., Cheng, CK. Morphological changes of foveal cysts as a predictor for visual response to anti-vascular endothelial growth factor treatments in diabetic macular edema. Int Ophthalmol 43, 2751–2762 (2023). https://doi.org/10.1007/s10792-023-02674-6

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  • DOI: https://doi.org/10.1007/s10792-023-02674-6

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