Development of a 1‐year risk‐prediction nomogram for good functional response with anti‐VEGF agents in naive diabetic macular oedema

Gabrielle, Pierre‐Henry; Massin, Pascale; Arnould, Louis; Couturier, Aude; Bouché‐Pillon, Jacques; Maupin, Edouard; Aho-Glélé, Serge; Bron, A.; Kodjikian, Laurent; Creuzot‐Garcher, Catherine

doi:10.1111/aos.14428

Cited by 3 publications

(2 citation statements)

References 36 publications

(45 reference statements)

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“…Although anti-VEGF treatment was proved to function better than previous therapies of laser therapy and steroid therapy, it had some limitations as well ( 22 – 24 ). Patients need long-term and consecutive anti-VEGF injections, and the complication morbidity will increase with the treatment progress ( 7 , 25 , 26 ). The potential ocular complications include entophthalmia, glaucoma, and retinal detachment, which can lead to a more severe visual loss ( 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

The Fundus Structural and Functional Predictions of DME Patients After Anti-VEGF Treatments

et al. 2022

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Diabetic retinopathy (DR) is an important complication with a high incidence of 34.6% in the diabetic populations. DR could finally lead to vision impairment without effective interventions, during which, diabetic macular edema (DME) is a key phase causing visual loss. Up to date, antivascular endothelial growth factor (anti-VEGF) therapy is the first-line treatment for DME which has achieved relatively better clinical outcomes than traditional treatments. However, there are several kinds of anti-VEGF medicines, and patients are sensitive to different anti-VEGF treatments. In addition, its effectiveness is unstable. Considering the patients’ need to accept continual anti-VEGF treatments and its price is comparatively high, it is clinically important to predict the prognosis after different anti-VEGF treatments. In our research, we used the demographic and clinical data of 254 DME patients and 2,763 optical coherence tomography (OCT) images from three countries to predict the fundus structural and functional parameters and treatment plan in 6 months after different anti-VEGF treatments. Eight baseline features combined with 11 models were applied to conduct seven prediction tasks. Accuracy (ACC), the area under curve (AUC), mean absolute error (MAE), and mean square error (MSE) were respectively used to evaluate the classification and regression tasks. The ACC and AUC of structural predictions of retinal pigment epithelial detachment were close to 1.000. The MAE and MSE of visual acuity predictions were nearly 0.3 to 0.4 logMAR. The ACC of treatment plan regarding continuous injection was approaching 70%. Our research has achieved great performance in the predictions of fundus structural and functional parameters as well as treatment plan, which can help ophthalmologists improve the treatment compliance of DME patients.

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Section: Discussionmentioning

confidence: 99%

The Fundus Structural and Functional Predictions of DME Patients After Anti-VEGF Treatments

et al. 2022

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“…Враховуючи, що сучасна діагностика ДНМ та прогнозування відповіді на лікування базується переважно на оцінці даних офтальмологічних досліджень, переважно ОКТ [23], не виключено, що додавання у панель діагностики селектинів, які мають безпосереднє відношення до механізмів ДНМ, суттєво покращить ефективність його прогнозу, а вміст селектинів у крові може розглядатися як критерій ефективності різних методів лікування ДНМ.…”

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Blood selectin levels as a predictive factor for diabetic retinopathy and diabetic macular edema in type 2 diabetes

Риков,

Чугаєв,

Зяблинцев

2023

Oftalmol Zh

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Background: Diabetes mellitus (DM) is still a noninfectious global pandemic. Diabetic retinopathy (DR) is one of the most common and socially significant complications of both type 1 and type 2 diabetes. Predicting the probability of DR progression and potential diabetic macular edema (DME) development is still important. Currently available predictive models include a wide number of predictors, and such predictors as blood selectin levels seem to be promising. Purpose: To determine relationships between blood levels of selectins and DR progression and DME development in patients with T2DM, and to develop particular predictive models. Material and Methods: Of the 124 patients (124 eyes) involved into this study, 95 (95 eyes) had T2DM and retinopathy (group 1 of 29 eyes with mild non-proliferative DR (NPDR); group 2 of 35 eyes with moderate or severe non-proliferative NPDR; and group 3 of 31 eyes with proliferative DR (PDR)), and 29 (29 eyes) had no diabetes (controls). Patients underwent a routine eye examination and spectral domain optical coherence tomography (SD-OCT) to determine central retinal thickness (CRT). The presence of DME was based on an increased macular thickness in the Early Treatment Diabetic Retinopathy Study (ETDRS) subfields compared to the upper limit of normal for patient's age and gender. Enzyme-linked immunosorbent assay (ELISA) kits from Invitrogen Thermo Fisher Scientific (USA) were used to determine selectin levels in blood. Statistical analyses were conducted using MedStat and MedCalc v.15.1 (MedCalc Software bvba) software. Results: There was a statistically significant tendency for an increase in progression of DR to be accompanied by an increase in blood selectin levels. In the presence of DME, blood LS levels were statistically significantly increased in mild NPDR; blood PS levels, in PDR; and blood ES levels, in all stages of DR. A regression model for predicting the progression of DR was built. In the model developed, diabetes duration and blood selectin levels were positively correlated, while HbA1c level was inversely correlated with DR progression. The model was found to be adequate R2adjust = 0.84; F = 97.9, p less 0.001, demonstrating high correlation of the selected independent variables with the stage of DR. The calculated Y index may be considered a quantitative reflection of the severity of DR. A patient is predicted to have mild NPDR (with a prediction accuracy of 86.2%) if Y less 1.5, moderate of severe NPDR (with a prediction accuracy of 88.6%) if 1.5 less equal Y less 2.35, and PDR (with a prediction accuracy of 100%) if Y more equal 2.35. A regression model for predicting the development of DME was built, with CRT and blood ES level found to increase the risk of the development of DME. A high AUC value for the ROC curve (AUC = 0.97; 95% CI, 0.92-0.99) indicated a very strong correlation of the risk of DME development with the levels of selected independent variables. In addition, sensitivity and specificity values at the optimal cut-off point were 93.2% (95% CI, 83.5%-98.1%) and 92.3% (95% CI, 83.0%-97.5%), respectively. Conclusion: Our findings confirmed the current view that high blood selectin levels are important in the presence of T2DM and related to major pathogenetic mechanisms of microvascular complications, and blood selectin levels can be considered predictors of the progression of DR as well as the development of DME.

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From randomised controlled trials to real-world data: Clinical evidence to guide management of diabetic macular oedema

Gabrielle,

Mehta,

Barthelmes

et al. 2023

Progress in Retinal and Eye Research

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Development of a 1‐year risk‐prediction nomogram for good functional response with anti‐VEGF agents in naive diabetic macular oedema

Cited by 3 publications

References 36 publications

The Fundus Structural and Functional Predictions of DME Patients After Anti-VEGF Treatments

The Fundus Structural and Functional Predictions of DME Patients After Anti-VEGF Treatments

Blood selectin levels as a predictive factor for diabetic retinopathy and diabetic macular edema in type 2 diabetes

From randomised controlled trials to real-world data: Clinical evidence to guide management of diabetic macular oedema

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