Optical Coherence Tomography Patterns in Diabetic Macular Edema can Predict the Effectiveness of Intravitreal Bevacizumab Combined with Macular Photocoagulation

Abstract

Purpose: To compare the effectiveness of intravitreal bevacizumab (IVB) combined with macular photocoagulation (MPC) for the treatment of patients with different optical coherence tomography (OCT) patterns of diabetic macular edema. Methods:In this prospective study were included 72 eyes of 58 patients with nonproliferative diabetic retinopathy (NPDR) and nontractional DME with central macular thickness (CMT) over 300 μm. The eyes were categorized into three groups according to OCT features: 22 eyes with diffuse retinal thickening (DRT), 30 eyes with cystoid macular edema (CME), 20 eyes with serous retinal detachment (SRD). All patients received a single dose (1.25mg/0.05ml) of IVB. MPC was applied one month later (25-30 days). Early Treatment Diabetic Retinopahty Study ( ETDRS) best corrected visual acuity (BCVA) and СМТ were assessed before and after the treatment (in the 1st, 3rd and 6th month).Results: At month 6, mean BCVA changed with +8.27 ± 10.7 ETDRS letters (P=0.074), -0.97 ± 8.2 ETDRS letters (P=0.351) and +1.8 ± 10.1 ETDRS letters (P=0.925), respectively, for DRT, CME and SRD groups. Mean CMT decreased by 80.7 ± 65.7 μm (P=0.003) in DRT group, by 24.5 ± 104.6 μm (P=0.909) in CME group and by 51.7 ± 124.3 μm (P=0.580) in SRD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT as compared with the CME and SRD groups. Conclusions:Intravitreal injection of bevacizumab combined with MPC is more effective in the DRT pattern than in the CME or SRD patterns of DME. The pattern of DME shown by OCT may predict the effectiveness of combination treatment.

Change of Optical Coherence Tomography Morphology and Associated Structural Outcome in Diabetic Macular Edema after Ranibizumab Treatment

“…Furthermore, pathologic fibrocellular changes at the vitreomacular interface are present in eyes with DME irrespective of the type of macular edema as classified by SD-OCT. Several patterns of macular edema depending on the location of intracellular or extracellular fluid have been first described by Otani et al [15]. Investigators have found variable results for visual and anatomic improvement in different groups after anti-VEGF treatment [4][5][6][7][16][17][18][19][20][21][22]. Similarly to our current study, changes in OCT parameters over time after IVIR treatment were noted.…”

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

“…16 Several patterns of macula edema depending on the location of intracellular or extracellular fluid were first described by Otani et al 17 Though the vasogenic or inflammatory etiology of DME is very difficult to distinguish from OCT, several studies attempted to identify the DME pattern in predicting the evolution of the disease and its response to treatment. 8,9,11,12,[18][19][20][21][22][23] Investigators have found variable results for visual and anatomic improvement in different groups after IVB treatment. Several studies suggested that eyes with CME may benefit more from IVB treatment than eyes with more diffuse patterns of DME, 9,12,21,22 while others proposed better effectiveness in the DRT type or even not predictive of OCT response.…”