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Temporal variation of optical coherence tomography biomarkers as predictors of anti-VEGF treatment outcomes in diabetic macular edema

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To report a longitudinal analysis of specific optical coherence tomography (OCT) features in eyes with diabetic macular edema (DME) treated with anti-VEGF.

Methods

A total of 133 eyes of 103 consecutive patients with center-involving DME were included in the study. The eyes were treated between August 2008 and April 2019 with three monthly intravitreal anti-VEGF injections, either with or without prompt or deferred laser, followed by pro re nata (PRN) re-treatment. The following OCT biomarkers were evaluated: subfoveal neuroretinal detachment (SND) (defined as present (SND+) or absent (SND-)), hyperreflective retinal foci (HRF) number (defined as: absent/few(HRF-) or moderate/many (HRF+)), external limiting membrane (ELM) integrity, central macular thickness (CMT), and central retinal thickness (CRT). Changes in SND status and in the number of HRF were evaluated at each DME recurrence throughout the follow-up(FU) period. Mutual correlation among OCT biomarkers and their relationship with visual and anatomic outcomes were assessed both at baseline and over the FU period.

Results

The mean FU was 71.2 months (SD 28.4; min. 12–max. 111). At baseline, the prevalence of SRD+ was 27.8% and a high number of HRF were detected in 41.4% of the eyes. A significant reduction in the number of HRF, CMT, CRT, and in the prevalence of SND was recorded in the post-loading phase (p-value <0.0001). In DME recurrences, the presence of SND+ and HRF+ was significantly more frequent in eyes with baseline SND+ and HRF+ compared to eyes presenting baseline SND- and HRF- (p-value <0.0001). No role of SND (p-value: 0.926) and HRF (p-value: 0.281) as baseline predictors of visual and anatomic outcomes was demonstrated, while a worse visual outcome was significantly correlated with a higher incidence of relapsing SND+ (p-value <0.0001) and HRF+ (p-value <0.0028) throughout the FU period.

Conclusion

In this study, SND and HRF were frequently present in DME recurrences with the same pattern exhibited at baseline, suggesting that these OCT biomarkers may characterize a specific pattern of DME that repeats over time. Moreover, the results suggested that the persistence and recurrence of SND and HRF may account for a decrease in visual function more than the baseline prevalence of these biomarkers. Further studies are required to confirm these findings.

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Data Availability

Not applicable.

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Acknowledgements

The authors thank Brian Hawkins for his linguistic revision.

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Authors and Affiliations

  1. IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, 37024, Verona, Italy

    Emilia Maggio, Maurizio Mete, Mauro Sartore, Francesco Bauci, Massimo Guerriero, Antonio Polito & Grazia Pertile

  2. Department of Cultures and Civilizations, University of Verona, 37134, Verona, Italy

    Massimo Guerriero

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  1. Emilia Maggio
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Correspondence to Emilia Maggio.

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Patients gave informed consent for the treatment and the inclusion in the study.

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Supporting information

ESM 1

Fig. 1 of the Supporting Information. A. Improvement in visual acuity in SND- and SND+ eyes after the loading phase and up to the 6-year time point. B. Improvement in visual acuity in HRF- and HRF+ eyes after the loading phase and up to the 6-year time point. C. Improvement in central macula thickness in SND- and SND+ eyes after the loading phase and up to the 6-year time point. D. Improvement in central macula thickness in HRF- and HRF+ eyes after the loading phase and up to the 6-year time point. (PDF 35 kb)

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Maggio, E., Mete, M., Sartore, M. et al. Temporal variation of optical coherence tomography biomarkers as predictors of anti-VEGF treatment outcomes in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 260, 807–815 (2022). https://doi.org/10.1007/s00417-021-05387-7

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