September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
OCT retinal thickness response after first intravitreal injection is a predictor of visual acuity response to anti-VEGF treatment of DME
Author Affiliations & Notes
  • Miguel Costa
    4C, AIBILI, Coimbra, Portugal
  • Ana Rita Santos
    CEC, AIBILI, Coimbra, Portugal
    CORC, AIBILI, Coimbra, Portugal
  • Sandrina Nunes
    4C, AIBILI, Coimbra, Portugal
  • Dalila Alves
    4C, AIBILI, Coimbra, Portugal
  • Christian Schwartz
    CORC, AIBILI, Coimbra, Portugal
  • Joao Figueira
    CEC, AIBILI, Coimbra, Portugal
    Ophthalmology Department, Coimbra University Hospital, Coimbra, Portugal
  • Silvia N Simao
    CEC, AIBILI, Coimbra, Portugal
    CORC, AIBILI, Coimbra, Portugal
  • Jose G Cunha-Vaz
    AIBILI, Coimbra, Portugal
    Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • Footnotes
    Commercial Relationships   Miguel Costa, None; Ana Rita Santos, None; Sandrina Nunes, None; Dalila Alves, None; Christian Schwartz, None; Joao Figueira, None; Silvia Simao, None; Jose Cunha-Vaz, Novartis (C)
  • Footnotes
    Support  Novartis Grant
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2085. doi:
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      Miguel Costa, Ana Rita Santos, Sandrina Nunes, Dalila Alves, Christian Schwartz, Joao Figueira, Silvia N Simao, Jose G Cunha-Vaz; OCT retinal thickness response after first intravitreal injection is a predictor of visual acuity response to anti-VEGF treatment of DME. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2085.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : Identify early predictors of anti-VEGF treatment response in patients with diabetic macular edema (DME).

Methods : In a propspective observational study (NCT01947881, CHARTRES Study) Seventy-one diabetes type II patients with DME and indication for intravitreal injection (IVT) of Lucentis® were treated for at least 3 months with monthly IVT of Lucentis® and followed-up for an additional 3 months. All patients underwent best corrected visual acuity (BCVA) measurements according to ETDRS protocol and SD-OCT, and all images were graded by an independent Reading Centre obtaining a complete morphological characterization of DME before, during, and after treatment. An exploratory predictor analysis for the BCVA change after 3 IVTs (3 months) was carried out with multivariate linear regression for selection of predictors and ROC curve analysis for determination of predictive performance and threshold selection.

Results : Sixty-seven patients completed the study and were included in this analysis.
Central retinal thickness (CRT) decrease after first IVT (1 month) was found to be an independent predictor of BCVA treatment response at 6 months on a multivariate regression with baseline BCVA and baseline CRT as covariates (p=0.014). On a ROC analysis, the 8.7% CRT decrease was identified as the threshold that distinguished more accurately patients that recovered more than 5 BCVA letters at 3 months (sensitivity 71.7%, specificity 47.6%, ROC AUC 0.581). Patients with a decrease of 8.7% or more in CRT after first ITV injection (65.7 %) experienced a significantly greater improvement in BCVA letters after 3 months (8.5±7.2 letters) when comparing with patients with a CRT decrease < 8.7% (4.0±9.7 letters), p=0.038. BCVA improvement at 1 month was not significantly different between groups (p=0.102), but there was already a significant overall increase in BCVA at 1 month (4.0±6.4 letters, p<0.001). Patients with larger cysts responded better to treatment (Table 1) but the presence of larger cysts did not improve the predictive capability of CRT decrease.

Conclusions : CRT decrease ≥ 8.7% at one month, after the first ITV anti-VEGF injection for DME predicts a better BCVA recovery at 6 months independently of baseline BCVA or CRT. A more practical threshold of 10 % can be used with only a slight reduction in sensitivity.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Treatment response.

Treatment response.

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