Optical Coherence Tomographic And Fluorescein Angiographic Patterns In Diabetic Macular Edema: Prediction Of Visual Outcome After Intravitreal Bevacizumab

Abstract

 

Purpose:

 

To identify optical coherence tomography (OCT) and fluorescein angiographic (FAG) patterns of diabetic macular edema (DME) predictive of visual outcomes after intravitreal bevacizumab (IVB; Avastin) injections

 

Methods:

 

To date, thirty-nine eyes (29 patients) were studied that were given IVB injections for DME. Preoperative OCT and FAG images were retrospectively examined by retina specialists. We categorized OCT features into four patterns adjusted from N R Kim, Y J Kim, H S Chin, et al¹: diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD) and partial posterior vitreous detachment (PVD). FAG features were classified into two groups: focal DME or diffuse patterns. Changes in retinal thickness, best-corrected visual acuity (BCVA) and Early Treatment Diabetic Retinopathy Study acuity (ETDRS) after two IVB injections were measured. Student's T-test or Mann-Whitney test was used to investigate the association between the presence of OCT and FAG features and outcome measures after two IVB injections_{1. N R Kim, Y J Kim, H S Chin, et al. Optical coherence tomographic patterns in diabetic macular oedema: prediction of visual outcome after focal laser Photocoagulation Br J Ophthalmol 2009 93: 901-905}

 

Results:

 

The baseline retinal thickness was 473.81 µm (sd: 68.50) and baseline ETDRS was 61.45 (sd: 9.62). Mean follow-up time was 4.67 (sd: 9.02) months (range 1 to 59 months). The CME pattern was associated with better visual outcome after two IVB injections compared to other types (BCVA 0.06 vs. -0.28 respectively, p=0.016). PVD pattern was significantly associated with retinal thickness, with patients with partial PVD showing less decrease (mean 17 µm) in retinal thickness after two IVB injections than patients with fully attached or fully detached posterior vitreous (mean -81,3 µm, p=0.014). FAG features showed no relation with outcome measures²_{2. We would like to thank Jelle Vehof, who helped us with statistical analysis}

 

Conclusions:

 

Our data indicate that CME pattern is associated with better visual outcome after two IVB injections than other types. Patients with partial PVD achieved less reduction in retinal thickness compared to patients with fully attached or fully detached posterior vitreous after two IVB injections

 

Keywords: diabetic retinopathy