Abstract
Purpose :
Diabetic macular edema (DME) is a leading cause of blindness. Although new treatments comprising of anti-vascular endothelial growth factor (VEGF) and corticoid implants have helped to control the disease, there seems to be an important percentage of patients that do not have an optimal response. The purpose of the study is to evaluate the correlation of optical coherence tomography (OCT) data, biomarkers and signs with the persistence of diabetic macular edema after the first year of treatment.
Methods :
Fifty-four eyes of 37 patients receiving treatment for DME were included in the study.
A comprehensive ophthalmologic assessment was performed with evaluation of best-corrected visual acuity (BCVA),
followed by a Spectral-Domain OCT examination with active eye tracking at the beginning and at the conclusion of the study.
During the follow-up period of 12 months, the patients received a series of intravitreal injections (aflibercept, ranibizumab and dexametasone implant) as needed. The OCT morphological signs evaluated were subretinal fluid (SRF), intraretinal cystoid fluid (IRF), hard exudates (HE) and hyper-reflective foci (HRF). The central macular thickness (CMT) was also evaluated. Data from the patients were compared with the Mann-Whitney U test and the chi-squared test.
Results :
The mean age of the patients was 65,9 years, 26 (70,3%) were male and 11 (29,7%) were female. At the end of the 12 month treatment, 28 eyes (51,8%) had no macular edema and in 26 (48,3%) the edema persisted. At the beginning, all 54 eyes presented intraretinal fluid, 21 (38,8%) subretinal fluid, 34 (62,9%) hyper-reflective foci and 27 (50%) hard exudates. There was significant correlation between the incomplete response with a higher central macular thickness (mean group thickness: 516 μm vs 386 μm, p=0,044) but not with the initial visual acuity (p=0,23). No significant correlation between persistent edema and the rest of OCT data was found ( LSR p=0,087, HE p=0,059, HRF p=0,057).
Conclusions :
An important part of patients showed persistence of macular edema after one year of intensive treatment. Increased macular thickness seemed to have a correlation with the incomplete response to treatment. The identification of certain morphological signs with the OCT, could help with the prognosis and the treatment strategy such as drug combination and early switch between pharmacological agents.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.