Optical Coherence Tomography Baseline Predictors for Initial Best-Corrected Visual Acuity Response to Intravitreal Anti-Vascular Endothelial Growth Factor Treatment in Eyes With Diabetic Macular Edema

Santos, Ana Rita; Costa, Miguel; Schwartz, Christian; Alves, Dalila; Figueira, João; Silva, Rufino; Cunha-Vaz, Josè

doi:10.1097/iae.0000000000001687

Cited by 49 publications

(41 citation statements)

References 25 publications

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“…Amelioration of DRIL after 4 months treatment with anti-VEGF in eyes with DME was found to be predictive for better visual outcome in DME after 12 months (Sun et al 2015). Notably, DRIL seen on fewer OCT scans was shown to be associated with good VA after resolution of centre-involving DME Sun et al 2015;Santos et al 2018). A recent study further solidified the importance of DRIL as a relevant noninvasive biomarker by demonstrating an association between DRIL and increasing severity of diabetic retinopathy (Das et al 2018).…”

Section: Introductionmentioning

confidence: 91%

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Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant

Zur

Iglicki

Sala‐Puigdollers

et al. 2019

Acta Ophthalmologica

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Purpose To investigate disorganization of retinal inner layers (DRIL) as a biomarker in eyes with diabetic macular oedema (DME) treated by intravitreal dexamethasone (DEX) implant. Methods Multicentre, retrospective study including eyes with DME treated with DEX implant and follow‐up of 12 months after the first injection. OCT scans were evaluated for the presence of DRIL and other structural features. Best corrected visual acuity (BCVA) and central subfield thickness (CST) were recorded at baseline and at 2, 4, 6 and 12 months after treatment. Correlation between DRIL at baseline and outcomes after DEX treatment and the change in DRIL were analysed. Results A total of 177 eyes (177 patients; naïve, n = 131; refractory, n = 46) were included. Patients without DRIL at baseline gained significantly more vision and enjoyed greater reduction in CST over 12 months (both p = 0.03). DRIL at the boundary between the ganglion cell‐inner plexiform complex and inner nuclear layer improved in 48/64 eyes (75%, p < 0.001), while DRIL between the inner nuclear layer and outer plexiform layer improved in 27/77 eyes (35%, p = 0.004). Conclusions This is the first study to show that DEX implant has the potential to ameliorate DRIL. Patients without DRIL at baseline have a favourable outcome. DRIL may serve a robust biomarker in DME treated by DEX implant.

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Section: Introductionmentioning

confidence: 91%

“…; Santos et al. ). A recent study further solidified the importance of DRIL as a relevant noninvasive biomarker by demonstrating an association between DRIL and increasing severity of diabetic retinopathy (Das et al.…”

Section: Introductionmentioning

confidence: 98%

Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant

Zur

Iglicki

Sala‐Puigdollers

et al. 2019

Acta Ophthalmologica

View full text Add to dashboard Cite

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“…Resolving DRIL seemed to be a good indicator of subsequent visual improvement [109]. In addition, the presence and extent of DRIL before treatment are correlated with BCVA outcomes to anti-VEGF therapy after the loading dose of ranibizumab in treatment naive patients with DME [101]. Similarly, patients with DME showed gain in visual acuity if DRIL resolved compared with non-resolvers, whose visual acuity worsened.…”

Section: Disorganization Of the Retinal Inner Layers For Diabetic Macmentioning

confidence: 94%

“…Various other OCT measures have been studied, but none of these measures has been consistently demonstrated to account for visual outcomes in patients with DME, and most of these studies were conducted retrospectively in mixed treatment cohorts. Examples of these measures include the integrity of the ellipsoid zone (EZ) (formerly described as the inner segment/outer segment photoreceptor junction) [100,101], the integrity of the external limiting membrane [101,102], the visibility of the cone outer segment tips (COST) [103], as well as the presence of subretinal fluid [104] and hyperreflective foci [105,106].…”

Section: Disorganization Of the Retinal Inner Layers For Diabetic Macmentioning

confidence: 99%

“…Furthermore, intraretinal cystoid fluid has been named as a predictor of poor response to anti-VEGF treatment in a prospective study [101], as well as in two post hoc analyses [107,108] in large datasets of patients with DME using a machine-learning approach. Recently, disorganization of the retinal inner layers (DRIL) has been suggested to be a valid predictive biomarker for visual outcomes in patients with DME.…”

Section: Disorganization Of the Retinal Inner Layers For Diabetic Macmentioning

confidence: 99%

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Potential Imaging Biomarkers in the Development and Progression of Diabetic Retinopathy

Häfner¹,

Karst²,

Schmidt‐Erfurth³

2018

Early Events in Diabetic Retinopathy and Intervention Strategies

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Diabetic retinopathy (DR) is the most prevalent microvascular complication of diabetes and a leading cause of preventable blindness in the working-age population. However, due to a lack of suitable biomarkers, its prediction in asymptomatic patients is insufficient. Currently, DR is diagnosed at a stage when typical morphologic lesions become fundoscopically visible. Yet, chronically elevated blood glucose levels lead to characteristic alterations in retinal vessel caliber, blood flow, oxygen saturation, and the capillary network, which precede DR lesions. Furthermore, emerging evidence suggests that retinal neurodegenerative changes occur early in diabetes, initiating a disintegration of the retinal neurovascular unit prior to the appearance of microvasculopathy in DR. This chapter will discuss recent research achievements toward understanding the complexities of DR pathophysiology. It will focus on the nomination of potential imaging biomarkers for the prediction of DR development and progression using innovative structural, functional, and metabolic imaging techniques, including optical coherence tomography angiography (OCTA), retinal oximetry, ultra-wide field FA, and corneal confocal microscopy (CCM). Validation of these biomarkers would allow the identification of patients at high risk of developing DR and might initiate a swift move to early diagnosis and individualized care.

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Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion

et al. 2019

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inner layers (DRIL) has demonstrated significant correlations with visual acuity (VA) in center-involved diabetic macular edema. In patients with retinal vein occlusion (RVO) and secondary macular edema, DRIL may be a useful biomarker in determining VA outcomes. OBJECTIVE To examine whether DRIL at baseline and after treatment is associated with VA in RVO. DESIGN, SETTING, AND PARTICIPANTSA retrospective review of records of 147 patients 18 years or older with treatment-naive branch RVO (BRVO), central RVO (CRVO), or hemispheric RVO (HRVO), with a minimum of 12 months of follow-up, who presented to a tertiary ophthalmic center from December 1, 2010, to January 1, 2016, was conducted. Data collection continued through January 2017. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy, or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in 3 predefined regions on spectral-domain optical coherence tomography at baseline, 6 months, and 12 months. A third masked grader was used for discrepancies.EXPOSURES Anti-vascular endothelial growth factor (AVF) therapy (ranibizumab, aflibercept, or bevacizumab) determined by the treating physician. MAIN OUTCOMES AND MEASURESThe DRIL score at baseline for determining VA outcomes and correlation of VA with changes in DRIL burden in response to AVF therapy. RESULTSIn the 147 patients (mean [SD] age, 68.9 [13.1] years; 75 [51.0%] female), baseline DRIL was seen in 91 eyes (61.9%). In the BRVO group but not the CRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study (ETDRS) score (score of 66.7 for no DRIL vs 54.6 for DRIL, P = .002). Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at 6 months, adjusting for baseline VA (score change of 19.50 for no DRIL vs 12.72 for DRIL; P = .04). During 12 months, continued DRIL presence in BRVO was associated with less VA gain up to 6 months (score change of 6.2 for the DRIL increase group vs 18.6 for the DRIL decrease group vs 2.9 for the DRIL stable group; P = .02). Increasing DRIL scores in CRVO/HRVO were associated with reduced VA improvement at 6 months (score change of -0.12 for the DRIL increase group vs 16.90 for the DRIL decrease group vs 8.45 for the DRIL stable group; P = .002) and 12 months (score change of -1.91 for the DRIL increase group vs 17.83 for the DRIL decrease group vs 6.97 for the DRIL stable group; P < .001). CONCLUSIONS AND RELEVANCEBaseline DRIL presence and DRIL burden changes with AVF therapy for macular edema secondary to RVO may be useful biomarkers of ETDRS score improvements.

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Optical Coherence Tomography Baseline Predictors for Initial Best-Corrected Visual Acuity Response to Intravitreal Anti-Vascular Endothelial Growth Factor Treatment in Eyes With Diabetic Macular Edema

Abstract: Damage of ellipsoid zone, higher values of disorganization of retinal inner layers, and central retinal thickness decrease are good predictors of best-corrected visual acuity response to anti-vascular endothelial growth factor therapy.

Cited by 49 publications

References 25 publications

Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant

Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant

Potential Imaging Biomarkers in the Development and Progression of Diabetic Retinopathy

Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion

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