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Vivian Schreur, Lebriz Altay, Freekje Van Asten, Joannes Groenewoud, Jeroen Klevering, Carel C B Hoyng, Eiko de Jong; Hyperreflective foci predict treatment response to bevacizumab in patients with diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1896. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Biomarkers to predict treatment response to bevacizumab in patients with diabetic macular edema (DME) are currently lacking. Hyperreflective foci (HF) are well-circumscribed dots that can be visualized on spectral domain optical coherence tomography (SD-OCT) and are associated with the presence of DME. The purpose of this study was to investigate whether the presence of HF can be predictive for treatment response to bevacizumab in DME.
Medical charts of 51 eyes of 38 patients with type 2 diabetes mellitus diagnosed with DME scheduled for treatment with 3 consecutive injections with intravitreal bevacizumab were reviewed. LogMAR Visual acuity (VA) and central retinal thickness (CRT) on SD-OCT were evaluated before and 3 months after the first injection. Two independent experienced graders assessed the number of HF at the foveal centered B-scan of the SD-OCT prior to and after treatment with bevacizumab. Linear mixed model analyses were performed to assess the associations between number of HF and baseline VA and CRT, as well as treatment response in terms of decrease in CRT and VA improvement.
Mean number of HF decreased from 14.7 ± 1.5 at baseline to 10.5 ± 1.0 after intravitreal treatment with bevacizumab (p=0.002). Mean CRT at baseline was 484 ± 21 μm and decreased to 424 ± 21 μm (p<0.001). VA was 0.55 ± 0.06 at baseline and improved to 0.49 ± 0.05 at the 3 month visit, although no statistical significance was reached (p=0.128). Linear mixed model analysis showed that baseline VA was worse when the number of HF at baseline was higher (estimated effect 0.012, 95% CI [0.003 – 0.033], p=0.014). No correlation between baseline number of HF and baseline CRT was found. Decrease in CRT after 3 months was independently correlated with both higher number of HF at baseline (estimated effect -2.47, 95% CI [-4.33 – -0.60], p=0.011) as well as higher baseline CRT (estimated effect -0.18, 95% CI [-0.32 – -0.03], p=0.022). No effect of the number of HF at baseline was found on improvement in VA.
In patients with DME, higher numbers of HF were associated with poorer VA. Additionally, baseline HF may be predictive for treatment response to bevacizumab in terms of CRT decrease.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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