Evaluation of markers of outcome in real-world treatment of diabetic macular edema

Abstract

ObjectiveTo evaluate short-term markers of outcome in diabetic macular edema (DME).MethodsProspective interventional case series included 122 eyes of 122 patients with recently diagnosed DME. Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter. Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness (SFCT) and central retinal thickness (CRT). Anatomic (10% CRT decrease) and functional responses (best corrected visual acuity, BCVA gain ≥5 letters) were assessed at 3 months and 6 months using univariate and multivariate analyses. Parameters tested were gender, duration of diabetes, HbA1c, hypertension, CRT, SFCT, BCVA, ellipsoid zone (EZ) status, subfoveal neuroretinal detachment (SND), anti-VEGF used and laser naivety. A logistic regression model was applied to find independent markers outcome.ResultsBCVA increased, CRT and SFCT decreased at 3 months and 6 months. Good metabolic control (p = 0.003), intact baseline EZ (p = 0.030), EZ re-grading at 3 M (p < 0.001) and laser naivety (p = 0.001) were associated with better functional outcome. The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response, while lower baseline BCVA and intact EZ are predictors of functional response.ConclusionThe presence of SND predicts anatomic response only, while an intact EZ is critical to achieve a good functional outcome in DME.Electronic supplementary materialThe online version of this article (10.1186/s40662-018-0119-9) contains supplementary material, which is available to authorized users.

Short-Term Outcomes of Refractory Diabetic Macular Edema Switch From Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience

“…Both factors correlated with better responses to DEX treatment in their respective aspects. Campos et al also found that lower baseline BCVA predicted a higher visual acuity gain (30). It may be suggestive of a "ceiling effect" that cannot be ruled out completely in this prediction model; that is, smaller improvements are required to achieve good vision in patients with better starting vision, while those with lower BCVA at baseline have greater capacity to achieved better vision outcome.…”

Short-term Outcomes of Refractory Diabetic Macular Edema Switch from Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience.

“…Campos et al also found that lower baseline BCVA predicted a higher visual acuity gain. 30 It may be suggestive of a 'ceiling effect' and can't be ruled out completely in this prediction model; that is, smaller improvements are required to achieve good vision in patients with better starting vision, while those with lower BCVA at baseline have greater capacity to achieved better vision outcome. Another limit of visual acuity improvement was the uncertant optimal timing for DEX switching in patients with DME non-responder to intravitreal ranibizumab.…”

Age, Initial Central Retinal Thickness, and OCT Biomarkers Have an Influence on the Outcome of Diabetic Macular Edema Treated With Ranibizumab– Tri-center 12-Month Treat-and-Extend Study

“…Among the OCT biomarkers, EZD is defined as having any discontinuity of the second hyper-reflective layer of fovea on OCT. The shadowing effect of cysts and retinal vessels was not regarded as part of the EZD ( 15 ).…”