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Nathan R Haines, Riley Sanders, Richard Yi-Jen Hwang, Jeffrey Olson; Correlation of diabetic macular edema intraretinal cyst reflectivity on SD-OCT to anti-VEGF treatment response. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4168.
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Current first-line treatment of diabetic macular edema (DME) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. While clinical trials have confirmed their efficacy in improving visual and anatomic outcomes, response to treatment is not universal, and identifying clinical or imaging characteristics that predict favorable or poor treatment response is desirable. On spectral-domain optical coherence tomography (SD-OCT), the degree of reflectivity of DME-associated intraretinal cysts is variable. Reflectivity of DME cysts was evaluated as a potential predictor of treatment response.
A retrospective chart review evaluated eyes with DME that were treated with anti-VEGF agents, and correlated the treatment response to reflectivity of intraretinal cystic spaces on SD-OCT. The NIH-sponsored software ImageJ was used to quantify intraretinal cyst and vitreous reflectivities on SD-OCT. Cyst-to-vitreous signal ratios were used to classify cysts as clear (< 2.00) or cloudy. Reponse to treatment was classified as a 10% or greater reduction in central foveal thickness (CFT). Pre and post-treatment visual acuities were also evaluated.
A review of twenty-seven eyes included 16 with clear intraretinal cysts on SD-OCT and 11 with cloudy cysts. Ten of 16 eyes (62.5%) with clear cysts and 5 of 11 (45%) with cloudy cysts achieved the treatment response of 10% or greater reduction in CFT. Mean reduction in CFT was 16.9% for eyes with clear cysts and 18.1% in those with cloudy DME. LogMAR visual acuity improved from 0.556 to 0.380 (Snellen equivalent 20/72 to 20/48) in eyes with clear cysts, and from 0.477 to 0.423 (20/60 to 20/53) in those with cloudy cysts.
Clinical and/or imaging characteristics aiding the prediction of treatment response in eyes with DME are desirable to assist patient counseling. Given visual and anatomic responses to anti-VEGF agents vary, the SD-OCT characteristic of intraretinal cyst reflecitivity was evaluated as a predictor of treatment response. Review of outcomes indicated that this OCT characteristic is not predictive of treatment response with regards to reduction in central foveal thickness or visual acuity improvement.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
SD-OCT images of clear (A) and cloudy (B, C) cysts due to diabetic macular edema. Cyst-to-vitreous reflectivity ratios calculated using ImageJ software: 1.53 for A, 2.97 (B), and 2.20 (C).
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