Abstract
Purpose :
Incomplete response to anti-VEGF treatment in patients with CI-DME is often encountered with the widespread use of sensitive spectral-domain optical coherence tomography (SD-OCT) imaging, posing a challenge on the decision whether to further inject or observe. Our retrospective observational study characterizes the anatomic features of persistent intraretinal cysts and correlates them with functional parameters such as visual acuity. This may provide a better understanding of their clinical significance.
Methods :
We have performed a detailed analysis of OCT scans of 9 eyes from 9 patients who demonstrated an incomplete response to anti-VEGF therapy, defined as persistence of one to three intraretinal cysts, without evidence of diffuse macular thickening, multiple cysts, or disruption of the retinal layers. Anatomic parameters included size and number of cysts, location in relation to the fovea, retinal layers involved, hyperreflectivity, the presence of hyperreflective foci and adjacent microaneurysms. Clinical data included severity of retinopathy, age, sex, and best-corrected visual acuity.
Results :
Patients included 6 males and 3 females with a mean age of 63 years and with varying severity of diabetic macular edema. Six out of nine patients had a single intraretinal cyst on OCT. Average dimension of a cyst was 206 microns in height and 464 microns in width, with an average distance from the center of the cyst to the fovea of 328 microns. The most common involvement pattern of retinal layers was from the inner plexiform layer to the outer nuclear layer. Five patients demonstrated the presence of adjacent hyperreflective foci. Best corrected Snellen visual acuity ranged between 20/25 to 20/30.
Conclusions :
This analysis of patients with diabetic macular edema who have suboptimal response to anti-VEGF agents has shown that despite proximity to fovea and relatively large size, overall visual acuity was good. Expanding this analysis to a larger population size can help to better define and identify those features which are low-risk for visual acuity loss and recurrence of fluid. This may potentially assist in reducing the number of needed injection and their associated risks.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.