To establish the morphological and functional parameters to predict the effectiveness of intravitreal injections (IVI) of ranibizumab in macular edema due to retinal vein occlusion and to develop a mathematical model for personalized treatment algorithms.
Material and methods
This is a retrospective study of 98 patients (98 eyes) with macular edema, who received IVI of ranibizumab and were followed up for 12 months. Spectral optical coherence tomography scans and best corrected visual acuity (BCVA) assessments were conducted every 3 months. Treatment outcome predictors were calculated based on logistic regression analysis.
The most significant prognostic factors for the long-term BCVA were baseline BCVA (OR 11.1, p = 0.001), foveal volume (OR 10.8, p = 0.001), destruction of external limiting membrane (OR 15.8, p = 0.001), photoreceptor inner/outer segments (OR 11.1, p = 0.001) and retinal pigment epithelium (OR 9.1, p = 0.001). It has also been discovered that post-treatment BCVA correlated with the height of serous retinal detachment (SRD) (r = −0.4, p = 0.001), ganglion cell complex thickness (r = + 0.3, p = 0.01) and focal loss of ganglion cells (r =−0.3, p = 0.005). Patients without SRD required fewer ranibizumab injections (3.8 ± 1.1) for macular edema fluid resorption compared to those with SRD (5.7 ± 1.2, p = 0.03). A mathematical model for predicting and personalized approach therapy of ranibizumab has been obtained (accuracy of 89%).
The effectiveness of IVI of ranibizumab depends on baseline morphological and functional changes. The obtained mathematical model allows for predicting the outcomes of therapy, determining individualized algorithms to increase the treatment effectiveness and to prevent low vision that corresponds to the principles of predictive, preventive, and personalized medicine.
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The study was approved by the ethics committee of Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the Ministry of Health of the Russian Federation.
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Khokhlova, D.Y., Drozdova, E.A., Kurysheva, N.I. et al. Optical coherence tomographic patterns in patients with retinal vein occlusion and macular edema treated by ranibizumab: a predictive and personalized approach. EPMA Journal 12, 57–66 (2021). https://doi.org/10.1007/s13167-021-00233-6
- Macular edema
- Retinal vein occlusion
- Blood-retinal barrier permeability
- Endothelial dysfunction
- Risk factors
- Optical coherence tomography
- Predictive preventive personalized medicine
- Mathematical model
- Individualized treatment algorithms
- Individual outcomes