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Sheelah Antao, Namritha Patrao, Dawn Sim, Philip Hykin, Sobha Sivaprasad, Robin Hamilton, Catherine A Egan, James W B Bainbridge, Richard Andrews, Ranjan Rajendram; Clinical, OCT and FFA characteristics of patients losing >5 letters BCVA following intravitreal ranibizumab therapy for diabetic macular oedema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1740.
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© ARVO (1962-2015); The Authors (2016-present)
To assess baseline clinical, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings in patients who lost >5 ETDRS letters from baseline to 6 months during intravitreal ranibizumab therapy for diabetic macular oedema (DMO).
225 eyes of 178 patients diagnosed with centre-involving DMO with visual acuity (VA) ≤79 ETDRS letters, central retinal thickness (CRT) ≥400 microns on OCT and foveal avascular zone (FAZ) greatest linear diameter ≤1500 microns on FFA were included. Patients received a loading phase of 3 intravitreal ranibizumab injections and had at least 6 months follow-up. Eyes that lost >5 ETDRS letters and received at least 4 injections were included and the baseline OCT scans and fluorescein angiograms of these eyes were reanalysed.
12 eyes (5.3%) lost > 5 EDTRS letters at 6 months. One eye had developed an unrelated central retinal artery occlusion and another had a dense vitreous haemorrhage secondary to aggressive proliferative diabetic retinopathy. The 10 cases lost a mean of 13.6 (SD 3.7) letters despite a mean reduction in CRT of 33.1 (SD 145.4) microns. The mean area of the foveal avascular zone (FAZ) on FFA was 0.55mm2 (SD 0.32) (range 0.21mm2 to 1.01mm2), and the mean greatest linear diameter of the FAZ was 0.98mm (SD 0.29) (range 0.56 to 1.43mm). 8 eyes (80%) had perifoveal capillary loss (PFCL) on FFA ranging from mild to severe, with 8 eyes (80%) having moderate or severe loss. Subfoveal disruption of the inner segment/outer segment (IS-OS) junction on OCT at baseline was noted in 9 eyes (90%) with cystoid changes in 10 (100%) eyes and 9 eyes (90%) had an epiretinal membrane. Vitreoretinal tractional elements were observed in 2 (20%) eyes and the presence of subretinal fluid was noted in 3 eyes (30%). 9 (90%) eyes had undergone prior macular laser compared with 64% in the total treated group.
The data suggest that baseline OCT and FFA features such as subfoveal IS-OS disruption, cystoid changes, presence of an epiretinal membrane, and moderate perifoveal capillary loss are features of eyes at risk of early visual acuity decline following intravitreal ranibizumab treatment for DMO and that further work is indicated to define whether such cases can evolve into long term non-responders.
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