Development and validation of a risk-prediction nomogram for poor functional response one year after treatment with anti-VEGF in naive-diabetic macular edema.

Abstract

Purpose : To develop and validate a risk-prediction nomogram for poor functional response during the first year of treatment with anti-VEGF agents in naive-diabetic macular edema (DME).

Methods : This was retrospective study involving patients with naive DME treated with anti-VEGF agents intravitreal injections and followed-up during one year in the Ophthalmology department of Dijon University Hospital between February 2010 and March 2015 (derivation cohort) and in several French ophthalmology centers between January 2014 and June 2015 (validation cohort). We used a program to generate nomogram based on binary logistic regression predictive models. We included variables that had significant associations with a poor functional response to anti-VEGF agents during the first year of treatment, defined as recovering a best corrected visual acuity (BCVA) < 80 letters according to the ETDRS chartsUsing regression coefficient, we calculated scores for each variable, and estimated the event probability. Model validation was performed using bootstrap method to quantify our modeling strategy and receiver operator characteristic curves (ROC). The nomogram was tested on a separate validation cohort using ROC analysis and goodness-of-fit tests.

Results : Data from 161 eyes (109 patients) in the derivation cohort and 100 eyes (100 patients) in the validation cohort were analyzed. In the final model, the following variables were associated with a poor functional response during the first-year of treatment: age, baseline BCVA and baseline ellipsoid zone (EZ) disruption on spectral-domain optical coherence tomography (SD-OCT). The resulting nomogram showed excellent discrimination for poor functional responders (area under the curve [AUC] 0.906, 95% confidence interval [CI] 0.849-0.964, P=0.0037 for the derivation cohort; [AUC] 0.942, 95% confidence interval [CI] 0.879-0.978, P< 0.001 for the validation cohort).

Conclusions : This study confirmed that age, baseline BCVA and ellipsoid band disruption on SD-OCT are important functional prognosis factors in naive DME treated with anti-VEGF agents. This nomogram provides a rapid and simple functional estimation of a poor functional response in naive-DME patients treated with anti-VEGF agents.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.