The Area and Number of Intraretinal Cystoid Spaces Predict the Visual Outcome after Ranibizumab Monotherapy in Diabetic Macular Edema

Abstract

Visual outcomes in diabetic macular edema (DME) after anti-vascular endothelial growth factor therapy vary across individuals. We retrospectively reviewed the clinical records for 46 treatment-naive eyes of 46 patients with DME who underwent intravitreal ranibizumab (IVR) monotherapy with a pro re nata regimen for 12 months. Overall, mean best-corrected visual acuity (BCVA) improved. Multivariate analyses adjusted for age and baseline BCVA showed that the area ratio, compared with the retinal area, and the number of intraretinal cystoid spaces evaluated on OCT (optical coherence tomography) images at baseline positively correlated with LogMAR BCVA and the extents of ellipsoid zone and external limiting membrane disruption at 12 months, and negatively correlated with central retinal thickness at the time of edema resolution. Therefore, a high area ratio and large number of intraretinal cystoid spaces resulted in a disorganized outer retinal structure at 12 months, a thin and atrophic retina after edema resolution, and a worse visual outcome. The area ratio and number of intraretinal cystoid spaces on initial OCT images were predictors of the visual outcome after IVR therapy in DME irrespective of baseline age and BCVA. The factors were related to retinal neurodegenerative changes in DME and could help in obtaining proper informed consent before treatment.

Prediction of Visual Acuity after anti-VEGF Therapy in Diabetic Macular Edema by Machine Learning

“…Previous studies have investigated the predictive factors of treatment outcomes after anti-VEGF therapy in eyes with DME, including OCT data and clinical data [ 18 , 31 , 35 – 38 ]. OCT images are essential for managing the treatment strategy of DME, which provides a way to objectively detect the treatment response [ 22 – 24 , 35 ].…”

“…Previous studies have investigated the predictive factors of treatment outcomes after anti-VEGF therapy in eyes with DME, including OCT data and clinical data [ 18 , 31 , 35 – 38 ]. OCT images are essential for managing the treatment strategy of DME, which provides a way to objectively detect the treatment response [ 22 – 24 , 35 ]. Data obtained from OCT images, such as different OCT morphologic characteristics of DME, retinal thickness, the height of cysts, DRIL, hyperreflective foci, and the integrity of ELM and IS/OS, have been shown as the predictors of treatment responses following anti-VEGF treatment [ 22 – 24 , 35 ].…”

“…OCT images are essential for managing the treatment strategy of DME, which provides a way to objectively detect the treatment response [ 22 – 24 , 35 ]. Data obtained from OCT images, such as different OCT morphologic characteristics of DME, retinal thickness, the height of cysts, DRIL, hyperreflective foci, and the integrity of ELM and IS/OS, have been shown as the predictors of treatment responses following anti-VEGF treatment [ 22 – 24 , 35 ]. In the present study, our results showed that CMT, vertical height of the largest cysts, and the number of cysts were important predictive factors for VA prognosis in patients with DME.…”

Smooth Border Between Inner Nuclear/Outer Plexiform Layers: Branch Retinal Vein Occlusion Biomarker of Fewer Macular Edema Recurrences

“…Researchers recently reported the potential predictive value of imaging biomarkers on high-resolution optical coherence tomography (OCT), which enables quantitative assessments, including intraretinal cystoid spaces, 9,10 intraretinal hyperre ective foci, 9,10 a highly re ective line, 11 subretinal uid, 9,12 disorganization of the retinal inner layers, 9,13,14 external limiting membrane disruption, 9,15,16 ellipsoid zone disruption, 9,11,15 and foveal bulge. 16 The locations of abnormal uid accumulation in the retina also have been investigated in eyes with ME in BRVO; Shroff et al reported three distinct anatomic patterns of structural changes on OCT, i.e., a serous retinal detachment in only 15%, cystoid ME in 40%, and a combination of the two in 45% 17 ; Yamaike et al reported that cystoid spaces were often seen in the inner nuclear layer (INL) (76%) and outer plexiform layer (OPL) (84%) on OCT images in eyes with BRVO 18 ; Yiu et al reported intraretinal uid in the INL, OPL, and outer nuclear layer in 78.1%, in the OPL and outer nuclear layer (19.3%), and in the INL (2.6%).…”

Hyperreflective Material in Optical Coherence Tomography Images of Eyes with Myopic Choroidal Neovascularization May Affect the Visual Outcome

“…Because it is non-invasive and requires a short recording time, OCT is also widely utilized for the follow-up of myopic CNV and of other macular diseases in the daily clinic. In general, OCT images are used to evaluate intraretinal conditions, including retinal edema [15,16] and disruptions of the ellipsoid zone (EZ) and external limiting membrane (ELM), which may reflect photoreceptor disorganization and affect the visual outcome [17][18][19], as well as subretinal lesions and/or fluid [19] in macular diseases. In OCT images, myopic CNV presents as a highly reflective area contiguous above the retinal pigment epithelium (RPE) (type 2 CNV [1]), usually with minimal fluid exudation [1].…”