<p>Optical Coherence Tomographic Patterns as Predictors of Structural Outcome After Intravitreal Ranibizumab in Diabetic Macula Edema</p>

Abstract

Background/Objectives: The purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT). Subjects/Methods: This retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings. Results: For a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007, <0.001, respectively). Conclusion: A trend toward decreased effectiveness after long-term IVR treatment was observed in the DRT group. Consistent IVR treatment could still achieve favorable improvement in the reduction of CMT in 2-year follow-up in the VMIA group. Different OCT patterns in DME may affect the therapeutic role of anti-VEGF agents and predict the structure outcome.

The Additive Effect of Topical Dorzolamide-Timolol with Intravitreal Ranibizumab Injection in Diabetic Macular Edema

“…19 Chen et al found that studied cases with OCT results of HRF, hyperlipidemia, & coronary artery disease had less improvement in CMT at twoyear follow-up after intravitreal ranibizumab injection. 14 In our study, 66.67% in group 1, 73.33% in group 2 had interrupted inner segment/ outer segment (IS/OS) layer. Zur et al suggested that eyes with continuous IS-OS layers had a good response 2 months after intravitreal dexamethasone implant.…”

Optical Coherence Tomographic morphological changes over the course of Ranibizumab Treatment in Diabetic Macula Edema

“…The CMT outcome at 2 nd year follow-up showed an average of 390.5 ± 75.3 µm in VIMA group, patients with morphological changes, which had considerable discrepancy in our previous work of favorable improvement in reduction of CMT in VMIA group with consistent IVR injections (13). This nding implies that patients with poor response, underlying physical mechanisms of pathogenesis other than VEGF may be involved and receive bene t from the treatment of surgical relief of traction (27).…”

“…Both ERM and VMT presented as a highly re ective band or membrane on the retinal surface. All patients were classi ed into four groups based on the OCT ndings, as our previous work have mentioned (13). DRT group included patients with only pure DRT.…”

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

“…Optical coherence tomography (OCT) and OCT angiography (OCTA) allow non-invasive recognition of imaging features that define a “DME profile”, distinguishing an inflammatory DME pattern characterized by the presence of subretinal fluid (SRF) and a high number of hyper-reflective foci (HRF) [ 4 , 5 ]. Furthermore, numerous imaging (OCT and OCTA) biomarkers have been identified in DME eyes as predictive of treatment response or disease progression, such as the retinal thickening characteristics [ 3 , 6 , 7 ], the presence, position, and internal reflectivity of microaneurysms (MAS) [ 8 , 9 ], the vitreomacular interface abnormalities (VMIAs) [ 6 ], the ellipsoid zone/external limiting membrane (EZ/ELM) integrity/disruption [ 7 ], the presence of nonperfusion areas (NPAs) [ 10 , 11 ], the foveal avascular zone (FAZ) abnormalities in terms of circularity and dimension [ 12 ], the involvement of deep capillary complex (DCP) [ 10 , 13 ], and the suspended scattering particles in motion (SSPiM) [ 14 , 15 ].…”