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Meera Radia, Christiana Dinah; Aflibercept for diabetic macular oedema (DMO): How effective with foveal intraretinal cysts?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4821.
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© ARVO (1962-2015); The Authors (2016-present)
In July 2015, NICE in the UK licensed use of intravitreal Aflibercept (Eylea) for DMO. There is currently little literature on Eylea therapy for resolution of foveal intraretinal cysts.We test the hypothesis that Eylea is effective in improving visual acuity (BCVA), reducing the central retinal thickness (CRT) and size of foveal intraretinal cysts in patients with DMO.
We retrospectively analysed patients treated with Eylea for DMO in a London-based eye unit (2015-2017). OCT macula scans were analysed by two independent examiners and included if ≥1 foveal intraretinal cyst present (defined as an intraretinal cyst any bulk of which lies in the central 1mm on OCT thickness map). Dataset for eyes from baseline to 12 months included BCVA,CRT,longest horizontal and vertical length of cyst,area of cyst and number of injections.Demographic data including age,sex,diabetic retinopathy grade and location of retinal fluid was also recorded.Paired t-test and Pearson's correlation coefficient was used for statistical analysis.
32 eyes of 23 patients were analysed. Mean age was 64 years (range 52 to 89). 13 eyes (40%) had pre-proliferative, 7 (22%) had proliferative and the remainder had background retinopathy. 12 eyes (37%) had a solitary foveal intraretinal cyst, 12 (37%) had foveal cysts with diffuse intraretinal fluid. The remainder had both with subretinal fluid.Baseline mean BCVA was 0.295 LogMAR, improving to 0.272 (p = 0.379) at 1 year. Baseline mean CRT (μm) reduced from 431.1 to 302.8 at 1 year (p = 0.0001).Baseline mean horizontal cyst size (mm) reduced from 0.578 to 0.171 at 1 year (p < 0.05). Baseline mean area of the foveal intraretinal cyst (mm2) reduced from 0.131 to 0.027 at 1 year (p =0.03),(r = 0.660). Mean number of injections per eye was 6.5 over 12 months (split into 10.7 for persistent cysts and 4 for resolving cysts).
To our knowledge this is the first clinical study looking at Eylea and foveal intraretinal cysts in DMO. We observed a significant reduction in CRT, horizontal cyst size and area of cyst at 1 year.While BCVA improved, this was not significant as some eyes had a good baseline BCVA. Some intraretinal cysts in DMO are more resistant to anti-VEGF therapy than others thus this study aids future prospective clinical studies to accurately predict outcomes/prognosis using variables like age, sex, diabetic retinopathy grade and location of retinal fluid.
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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