Abstract
Purpose :
Patients with diabetic macular edema (DME) in the UK are treated very early due to efficient screening programme and absence of baseline visual acuity (VA) criteria for initiating anti-VEGF in England and Wales. This study looked at the features of early responders.
Methods :
The spectral domain optical coherence tomography (OCT) characteristics and Early Treatment Diabetic Retinopathy Study VA letter scores of DME patients who underwent a loading phase of 3 aflibercept injections were assessed. VA change in eyes presenting with 78 letters or more were compared to those who had worse baseline visual acuity. Early good response was defined as VA after third injection of at least 84 letters or decrease in central subfield thickness (CST) by 100µm or more. Proportion of patients with a gain in 5 or more letters and CST<300um in both groups were assessed. Predictors of early good response were assessed.
Results :
Two hundred eyes were analysed. VA change was 1 letter loss in the better presenting vision group (n=29) compared to 6 letter gain in the poorer baseline vision group (n=171) (p=0.002). A gain of 5 or more letters were seen in 17% eyes in the better vision and 51% letters in the poorer baseline group (p=0.001). CST decreased by mean of 73 µm in the better presenting vision group compared to 112 µm in the poorer baseline vision group (p=0.042). Proportion of patients with CST<300um after injections was observed in 52% and 50% in the better and worse baseline VA groups respectively (p=0.887). Early good response was observed in 11 eyes in the better baseline group compared to 7 eyes in the poorer vision group. There were significant improvements in most OCT features from baseline to post-injections in both groups. Logistic regression comparing early responders against non-early responders for the whole group showed that those with cystoid DME were 10.54 times less likely to respond early than those with diffuse retinal thickening, p=0.015. Similarly, those with foveal cysts were less likely to respond early than those with no cysts (OR=24.35, p=0.048). Multivariable regression involving DME type, cyst location and cyst size, adjusting for baseline VA gave a pseudo-R2 value of 0.326.
Conclusions :
Aflibercept resulted in significant improvements in OCT features in both groups of presenting vision. Patients with CME and foveal cysts are less likely to respond early.
This is a 2020 ARVO Annual Meeting abstract.