September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
A quantitative approach to predict differential effects of anti-VEGF treatment on diffuse and focal leakage in patients with diabetic macular edema.
Author Affiliations & Notes
  • Michael J Allingham
    Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States
  • Dibyendu Mukherjee
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Erin Lally
    Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States
  • Hossein Rabbani
    Medical Image & Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
  • Priyatham S Mettu
    Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States
  • Scott W Cousins
    Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States
  • Sina Farsiu
    Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Michael Allingham, None; Dibyendu Mukherjee, None; Erin Lally, None; Hossein Rabbani, None; Priyatham Mettu, None; Scott Cousins, None; Sina Farsiu, None (P)
  • Footnotes
    Support  NIH grant 5K12EY016333-09; NIH grant R01 EY022691
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2076. doi:
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      Michael J Allingham, Dibyendu Mukherjee, Erin Lally, Hossein Rabbani, Priyatham S Mettu, Scott W Cousins, Sina Farsiu; A quantitative approach to predict differential effects of anti-VEGF treatment on diffuse and focal leakage in patients with diabetic macular edema.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2076.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : To use semi-automated segmentation of fluorescein angiography (FA) to determine whether anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME) differentially affects microaneurysm (MA) associated leakage, termed focal leakage, versus non-MA associated leakage, termed diffuse leakage.

Methods : We performed a retrospective study of 14 subjects treated with at least three consecutive injections of anti-VEGF agents for DME (mean 5.3 injections, range 3-9) who underwent Heidelberg FA prior to and following anti-VEGF therapy. Inclusion criteria were center involving DME and FA of adequate quality for analysis. Exclusion criteria included macular edema due to cause besides DME, concurrent treatment for DME besides anti-VEGF, macular photocoagulation within 1 year. At each time point, total leakage was automatically segmented using our previously published software (Rabbani et al. IOVS 2015). Microaneurysms were identified by an expert grader and leakage within a 100 micron radius of each MA was classified as focal leakage and automatically segmented. Remaining leakage was classified as diffuse leakage. The absolute and percent change in total, diffuse and focal leakage was calculated for each subject.

Results : Mean pretreatment total leakage was 5.20 mm2 and decreased by a mean of 24.4% (mean change -1.34 mm2) following treatment. Diffuse leakage decreased by a mean of 29.5% (mean absolute change -1.34 mm2) while focal leakage increased by 4.20% (mean absolute change +0.002 mm2).

Conclusions : Anti-VEGF treatment for DME results in decreased diffuse leakage but had relatively little effect on focal leakage as assessed by FA. This suggests that diffuse leakage may be a marker of VEGF-mediated leakage and that patients with predominantly diffuse pattern leakage may be more responsive to anti-VEGF therapy.

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

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