Abstract
Purpose :
To evaluate the potential prognostic role of biomarkers in Optical Coherence Tomography (OCT) in vitrectomized and non-vitrectomized eyes treated with intravitreal ranibizumab injections, in patients with diabetic macular edema.
Methods :
The eyes were grouped in vitrectomized (group 1) and non-vitrectomized (group 2). OCT biomarkers were assessed at baseline and at 12 months.
Primary endpoint: OCT biomarkers difference between both groups - presence of subretinal fluid (SRF), number of hyperreflective dots (HRD), disorganization of retinal inner layers (DRIL), disruption of outer plexiform layer (OPLd), external limiting membrane (ELMd), ellipsoid layer discontinuity (ELd) and presence of cysts in outer and inner nuclear layers (ONLc and INLc).
Secondary endpoint: OCT biomarkers difference and type of responder: 1) good-earlier responder: when beyond the 24th week of follow-up, there was a complete anatomical response (central foveal thickness, CFT, ≤ 300 µm) with an increase in best corrected visual acuity, BCVA, ≥5 letters; 2) non-responder: CFT >400µm or ≤ 10% of CFT reduction and BCVA gain <5 letters; 3) partial responder: between good and non-responder criteria.
Results :
A total of 45 eyes (10 vitrectomized and 35 non-vitrectomized) from 38 patients completed the follow-up. Mean age was 66.8±8.1 years. Comparing good-earlier responders vs partial/non-responders: 1) at baseline, the presence of INL cysts was lower in good responders (26.5% vs 73.5%, p=0.035); 2) at the end of follow-up, good responders maintained a lower percentage of INLc (26.5% vs 73.5%, p=0.035) and had a lower percentage of DRIL, OPLd and ONLc (12.0% vs 88.0%, p=0.001; 8.7% vs 91.3%, p<0.001; 17.4% vs 82.6%, p=0.013, respectively). An association between INLc and a higher glycated hemoglobin (p=0.028) was also observed at 12 months of follow-up.
Conclusions :
This study highlights the prognostic value of some SD-OCT parameters, such as fewer INLc, which were associated with a better therapeutic response.
According to our results, a normalization of the macular anatomy through the disappearance of DRIL, OPLd and ONLc with ranibizumab is most likely to happen in early complete responders.
The association between INLc and higher glycated hemoglobin levels reinforces the relevance of systemic metabolic control in diabetic microvascular manifestations.
This is a 2021 ARVO Annual Meeting abstract.