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Johannes Schiefelbein, Michael Müller, Christoph Kern, Tina Herold, Raffael Liegl, Dawn A Sim, Maximilian Weiß, Siegfried Priglinger, Karsten Ulrich Kortuem; Early improvement of central retinal thickness as a predictor for anatomical outcome and response in the treatment of diabetic macular edema with intravitreal injections of anti-VEGF. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3602.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study was to investigate relations between early improvement of central retinal thickness (CRT) and further therapy response in the treatment of diabetic macular edema (DME) with intravitreal injections of anti-VEGF.
We analyzed real life data from the database of the Dept. of Ophthalmology of Ludwig-Maximilians-University, Munich.57 patients and 68 eyes with center-involving DME were treated with intravitreal anti-VEGF therapy in our institution. All patient eyes started with a CRT ≥ 400 μm at baseline and were reviewed over a follow-up period of at least 360 days. All patients received at least 3 injections of anti-VEGF medication.We analyzed the SD-OCT (Spectralis, Heidelberg Engineering, Germany) and measured the visual acuity (VA) before and during the treatment. An anti-VEGF responder was defined by a reduction of more than 10% of the CRT after 90 days of treatment (57 eyes). A poor responder was defined by a reduction of 10% or less of the CRT after 90 days (11 eyes).
The mean VA and CRT at baseline were 0.61 (± 0.37) logMar (responder: 0.62 (±0.38) logMar; poor responder: 0.55 (±0.29) logMar) and 570.74 (± 143.06) μm (responder: 573.51(± 146.60) μm; poor responder: 556.36 (± 128.47) μm).On average, the VA changed by -0.097 (± 0.282) logMar after 90 days and by -0.085 (± 0.355) logMar after 360 days while the CRT changed by -190.29 (± 181.56) μm after 90 days and by -185.59 (± 189.52) μm after 360 days. We spotted a significant difference in the CRT after 90 days of treatment (p=0.001) between responder 342.98 (±108.72) μm and poor responder 574.55 (±149.09) μm. Moreover, the Mann-Whitney-U-Test showed significant differences in the change of the CRT after 90 days (p=0.001) and after 360 days (p=0.048) of treatment. In contrast, no significant differences in age, number of injections after 90 days and 360 days, VA and CRT at baseline, VA and CRT after 360 days could be found.
On average, responder showed a higher improvement in VA and in CRT after 360 days in comparison to poor responder, which in contrast did not show an improvement of the VA after 360 days. Early CRT reduction after 90 days may help predict which DME patients will respond more beneficially in further anti-VEGF pharmacotherapy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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