Correlation Between Ganglion Cell Layer Thinning and Poor Visual Function After Resolution of Diabetic Macular Edema

Bonnin, Sophie; Tadayoni, Ramin; Erginay, Ali; Massin, Pascale; Dupas, B.

doi:10.1167/iovs.14-15503

Cited by 63 publications

(60 citation statements)

References 15 publications

(16 reference statements)

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“…Furthermore, early 4-month change in DRIL extent predicted VA change from baseline to 1 year 44. Coinciding with this data is a publication by Bonnin et al ,45 which showed that despite favourable anatomic response, a thin ganglion cell-inner plexiform layer was associated with lower visual acuity despite normal thickness. This again suggests that inner retinal alterations occurring in DME would seem to strongly affect visual outcomes.…”

Section: Defining Responsesupporting

confidence: 54%

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

Ashraf

Souka²,

Adelman³

2016

Br J Ophthalmol

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

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Section: Defining Responsesupporting

confidence: 54%

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

Ashraf

Souka²,

Adelman³

2016

Br J Ophthalmol

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“…Other OCT studies reveal that in cases of diabetic macular edema associated with disorganization of the inner retinal layers, visual acuity improvement was related to restoration of the normal retinal layering (Radwan et al, 2015). Similar results were noted with regard to thickness of the ganglion cell layer, irrespective of the CRT (Bonnin et al, 2015). These studies suggest that while CRT is an important factor in the response to treatment and visual restoration, specific patterns of macular edema as well as restoration of normal retinal architecture are also important factors.…”

Section: Pathophysiology Of Diabetic Macular Edemasupporting

confidence: 67%

Functional outcome of macular edema in different retinal disorders

Tomkins-Netzer¹,

Ismetova

Bar

et al. 2015

Progress in Retinal and Eye Research

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“…RDN is clinically relevant, for example affecting the visual outcome after successful treatment of diabetic macular edema (26). Retinal neurodegeneration at the cellular and functional (ERG) level has been described previously (27) in another mouse model of spontaneous DM.…”

Section: Discussionmentioning

confidence: 90%

Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus

Sohn

Dijk

Jiao

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

491

437

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Diabetic retinopathy (DR) has long been recognized as a microvasculopathy, but retinal diabetic neuropathy (RDN), characterized by inner retinal neurodegeneration, also occurs in people with diabetes mellitus (DM). We report that in 45 people with DM and no to minimal DR there was significant, progressive loss of the nerve fiber layer (NFL) (0.25 μm/y) and the ganglion cell (GC)/inner plexiform layer (0.29 μm/y) on optical coherence tomography analysis (OCT) over a 4-y period, independent of glycated hemoglobin, age, and sex. The NFL was significantly thinner (17.3 μm) in the eyes of six donors with DM than in the eyes of six similarly aged control donors (30.4 μm), although retinal capillary density did not differ in the two groups. We confirmed significant, progressive inner retinal thinning in streptozotocin-induced "type 1" and B6.BKS(D)-Lepr db /J "type 2" diabetic mouse models on OCT; immunohistochemistry in type 1 mice showed GC loss but no difference in pericyte density or acellular capillaries. The results suggest that RDN may precede the established clinical and morphometric vascular changes caused by DM and represent a paradigm shift in our understanding of ocular diabetic complications.diabetes | retina | neurodegeneration | diabetic retinopathy | optical coherence tomography

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Correlation Between Ganglion Cell Layer Thinning and Poor Visual Function After Resolution of Diabetic Macular Edema

Cited by 63 publications

References 15 publications

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

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

Functional outcome of macular edema in different retinal disorders

Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus

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