Author: Özge Saritas (Turkey)
Co-authors: Yelda Yildiz Tasci, Yasin Toklu, Mücella Arikan Yorgun
To investigate factors associated with responses to intravitreal bevacizumab (IVB) in diabetic macular edema(DME) by spectral domain optical coherence tomography (SD-OCT).
Ankara Yildirim Beyazit University, Department of Ophthalmology, Ankara,Turke Ankara City Hospital, Ophthalmology Clinic, Turkey
In this retrospective study, patients with DME receiving intravitreal anti-VEGF therapy with PRN protocol after three months of loading therapy(1.25 mg bevacizumab/0.05 mL) were evaluated. Best corrected visual acuity (BCVA, Logmar), SD-OCT images were assessed before injection and at 3 months after injection. Central macular thickness (CMT), type of edema, number of hyper-reflective retinal spots (HRS, 0-20: mild, 20-40: moderate, above 40: advanced), extent of disorganization of inner retinal layers (DRIL), subretinal fluid (SRF), external limiting membrane irregularity, ellipsoid zone irregularity and vitreomacular interface were evaluated. Persistence of macular edema after three loading doses was evaluated as non-response to treatment. Patients who responded to the treatment were classified as group 1, and those who did not respond as group 2.
A total of 37 eyes of 37 patients (22 eyes in group 1 and 15 eyes in group 2) were evaluated. The mean age of the patients was 60.7 ± 8 (49-78), the female-to-male ratio was 16/21 (43% / 57%). There was no significant difference between two groups in terms of age and gender. (p> 0.05). The mean follow-up period was 10.6 ± 5 (6-24) months. The mean baseline CMT and BCVA values were not different between the Group 1 and 2 (p>0.05). The mean BCVA was 0.31, 0.35, 0.34 in Group 1 and 0.25, 0.27, 0.24 in Group 2 at baseline, 1st month and 3th month, respectively (p> 0.05 for all values). The mean CMT at baseline was 497 µm (320-782) in Group 1 and 524 µm (370-675) in Group 2. The mean CMT at 3 months were 352 (241-575), 432 (262-627) µm, in Group 1 and Group 2 respectively (p = 0.044). Diffuse macular edema and SRF were observed more in Group 1 than Group 2, which was not statistically significant (p> 0.05). In both groups, the SRF and HRN were tend to be lower after treatment but statistically insignificant (p> 0.05).
IVB treatment was associated with resolution of DME. Baseline OCT images can help us to determine prognosis in obtaining response to IVB. Nevertheless, we can get a better response to IVB in the presence of diffuse edema and subretinal fluid in diabetic macular edema.
None of the authors have reported funding/support.