Abstract
Purpose: :
to study spectral-domain optical coherence tomography (SD-OCT) parameters that may be of prognostic value in patients with diabetic cystoid macular edema (DCME)
Methods: :
A retrospective comparative analysis of patients diagnosed with new onset DCME that presented to the King Khaled Eye Specialist Hospital (KKESH) over a period of two years and who were treated with intravitreal bevacizumab (IVB) was conducted. Included patients had to have a SD-OCT macular scan and fluorescein angiography (FA) as part of their initial evaluation. Patients with ischemic, lipid, or vitreomacular traction maculopathy, those with unreliable OCT scans, and those with <6 months follow-up were excluded. Each of the OCT line scans obtained at baseline was analyzed for several variables indicative of the extent of retinal involvement by the cystoid change and its location with respect to the center. Univariate and multivariate analyses were performed comparing the SD-OCT findings among two groups of eyes: the "no improvement" group and the "improvement" group, based on visual acuity improvement of at least two Snellen lines between initial presentation and last follow-up. The main outcome measure was SD-OCT variables that may predict the visual outcome following IVB.
Results: :
Thirty-eight eyes matched the inclusion criteria of the study, 23 of those have been analyzed to date. The mean age of the patients was 56.9 ± 8.7 years with 15 (65.2%) males and 8 (34.8%) females. Over an average follow-up of 12.3 months, vision improved in 9 eyes (39.1%). Comparing the "no improvement" group and the "improvement" group using univariate analyses, 3 baseline SD-OCT parameters were found to be associated with visual improvement including the presence of residual bridging retinal processes centrally (p = 0.014) and the thickness of the photoreceptor inner segments within the central 1 mm subfield (p = 0.001) as well as centrally (p = 0.032). After adjusting for baseline log-MAR visual acuity, logistic regression analysis disclosed that both the presence of residual bridging retinal processes within the central 1 mm subfield (p = 0.041) and their central location (p= 0.005) were significantly associated with visual improvement.
Conclusions: :
Visual improvement following IVB for DCME appears to be more likely in eyes with residual central retinal processes noted on baseline macular SD-OCT. These findings may be helpful in patient counseling, case selection and clinical trial planning.
Keywords: retina • edema • imaging/image analysis: clinical