April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Predictive Morphological Factors Associated With Positive Response To Intravitreal Bevacizumab And Triamcinolone In Diabetic Macular Edema
Author Affiliations & Notes
  • Sonja G. Prager
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Katharina Kriechbaum
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Matthias Bolz
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Georgios Mylonas
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Bianca Gerendas
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Georg Rainer
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Christoph D. Scholda
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Ursula Schmidt-Erfurth
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • DRRG - Diabetic Retinopathy Research Group Vienna
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships  Sonja G. Prager, None; Katharina Kriechbaum, None; Matthias Bolz, None; Georgios Mylonas, None; Bianca Gerendas, None; Georg Rainer, None; Christoph D. Scholda, None; Ursula Schmidt-Erfurth, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 575. doi:
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      Sonja G. Prager, Katharina Kriechbaum, Matthias Bolz, Georgios Mylonas, Bianca Gerendas, Georg Rainer, Christoph D. Scholda, Ursula Schmidt-Erfurth, DRRG - Diabetic Retinopathy Research Group Vienna; Predictive Morphological Factors Associated With Positive Response To Intravitreal Bevacizumab And Triamcinolone In Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2011;52(14):575.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Intravitreal triamcinolone as well as anti-VEGF have been shown to be effective agents in the treatment of diabetic macular edema (DME). The aim of this study was to identify morphologic factors associated with functional improvement following three months of treatment, respectively.

Methods: : 32 patients with untreated clinically significant cystoid DME were included in this prospective, comparative interventional case series. They were randomized into two equal groups: 16 received three injections of 2,5mg bevacizumab at 1-month intervals and 16 patients received one initial injection of 8 mg triamcinolone followed by two sham injections. Study population was classified in two groups regarding BCVA improvement or worsening at month 3. Baseline characteristics in SD-OCT were evaluated regarding subretinal fluid (SRF), size of intraretinal cysts (IC), and photoreceptor inner segment (IS) and outer segment (OS) junction integrity. Baseline FA images were graded in regard to ischemic areas (IA), irregularly shaped foveal avascular zone (FAZ) and type of CME (focal or diffuse). Grading was performed by two readers of the Vienna Reading Center using a standardized protocol.

Results: : 23 subjects showed a statistically significant BCVA improvement from initially 0,32 logarithm of the minimum angle of resolution (logMAR) to 0,2 logMAR (p<0,001) at month 3 whereas nine subjects developed a statistically significant BCVA worsening from 0,26 logMAR to 0,38 logMAR (p=0,005) at month 3. Baseline characteristics were well balanced regarding sex, age, BCVA, central retinal thickness (CRT), size of IC and CME type. Patients treated with bevacizumab were more likely to gain vision than patients treated with triamcinolone though retinal thinning was comparable in both groups. Furthermore IS/OS integrity, regular FAZ as well as SRF at baseline were seen more often in patients with BCVA improvement after 3 months.

Conclusions: : Evaluation of retinal morphology by SD-OCT and FA may help to predict the individual treatment response secondary to intravitreal bevacizumab or triamcinolone injection in patients with diabetic macular edema.

Clinical Trial: : https://eudract.ema.europa.eu 2007-001553-26

Keywords: diabetic retinopathy • injection • imaging/image analysis: clinical 
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