Prospective microperimetry and OCT evaluation of efficacy of repeated intravitreal bevacizumab injections for persistent clinically significant diabetic macular edema

Abstract

To prospectively investigate morphologic and functional changes after intravitreal bevacizumab for persistent diffuse and clinically significant diabetic macular edema. In total, 26 eyes in 26 patients were treated with three intravitreal injections of bevacizumab (Avastin™) given at 4-week intervals. Study parameters included: visual acuity (VA), perceived visual improvement, central macular thickness as measured by Spectralis OCT, macular sensitivity and fixation pattern as measured by MP-1 microperimetry, and the incidence of ocular and systemic side-effects. At the time of follow-up, 76.9 % of eyes showed a significant improvement in VA (p = 0.012), 38.4 % showed a one-line improvement on the ETDRS chart compared with VA at day 0, 30.7 % showed a two-line improvement, and 7.6 % showed at least a three-line improvement. The mean central macular thickness was 447 microns at day 0 and 311.1 microns at follow-up (p = 0.003). The mean baseline macular sensitivity, by MP-1 microperimetry, was 8.29 dB; at follow -up, macular sensitivity had improved to 14.26 dB (p = 0.025). These results support further controlled trials on the efficacy of intravitreal bevacizumab in treating diabetic macular edema. Microperimetry and OCT are important tools in managing diabetic patients, providing a detailed study of the macular region, particularly when it is necessary to monitor the morphological and functional outcome after various interventions. A good correlation between retinal sensitivity and perceived visual performance was found.

Quantitative physiological measurements to evaluate the response of antivascular endothelial growth factor treatment in patients with neovascular diseases

“…Parallel to VA and anatomical improvement, most studies showed improvement of MP parameters after treatment in spite of the differences in patient characteristics, disease entities, and anti-VEGF therapy. [ 50 51 52 53 54 55 56 57 58 61 62 ] Macular sensitivity increase, absolute scotoma reduction, and stabilization of fixation estimated by MP strongly support evidence of macular function recovery, as suggested by other functional outcomes, after intravitreal anti-VEGF injections for neovascular disease. However, according to statistical analysis of the correlation with VA and OCT, the results were variable.…”

“…[ 51 ] Furthermore, these noninvasive procedures have an automatic eye tracker that compensates for eye movements during the examination, analyzing macular function even when fixation is unstable. [ 50 ] The value of such evaluations with MP has been previously reported in numerous studies assessing the efficacy and safety of anti-VEGF treatment in eyes with wet AMD,[ 49 51 52 53 54 55 ] macular edema secondary to RVO,[ 56 57 ] DMR,[ 58 59 60 ] and myopic CNV. [ 50 61 62 ] [ Table 2 ].…”

Supplementation with a highly concentrated docosahexaenoic acid plus xanthophyll carotenoid multivitamin in nonproliferative diabetic retinopathy: prospective controlled study of macular function by fundus microperimetry

“… 52 Microperimetry has also been useful for detailed study of the macular region for the assessment of morphological and functional outcome after intravitreal ranibizumab in patients with clinically significant DME. 53 However, as far as we are aware, studies assessing macular function by microperimetry in early stages of DR have not been previously published. In this respect, our study demonstrates the usefulness of microperimetry in this disease setting.…”

Functional outcome of macular edema in different retinal disorders

“…Following treatment for diabetic macular edema with anti-VEGF injections patients regained both visual acuity and retinal contrast sensitivity with improved retinal thickness (Malagola et al, 2013;Reznicek et al, 2013). These changes were not noted in patients treated with laser photocoagulation, who had improvement in retinal thickness but far less gain of both visual acuity and retinal contrast sensitivity (Comyn et al, 2014).…”