Optical coherence tomography patterns of diabetic macular edema and treatment response to bevacizumab: a short-term study

Comparison of the effect of ranibizumab in retinal vein occlusion and macular edema with different optical coherence tomographic patterns

AIM

To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab (IVR) in treating macular edema (ME) secondary to retinal vein occlusion (RVO).

METHODS

This retrospective study involved 65 RVO patients (65 eyes) who received IVR and were followed-up for more than 3mo. ME was categorized into cystoid macular edema (CME), diffuse retinal thickening (DRT), and serous retinal detachment (SRD) according to optical coherence tomography (OCT) images. The comparison of best corrected visual acuity (BCVA; logMAR) and central macular thickness (CMT) among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test. The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.

RESULTS

BCVA tended to improve in all groups, with marked improvement in CME and DRT groups. CMT showed the greatest reduction after 1wk, and remained stable over the following 3mo. DRT patients had the worst BCVA and the highest CMT at baseline, but the differences became smaller after IVR treatment. CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR. Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up. DRT patients were most likely to transform into the other morphological groups, while SRD patients showed minimal transitions. BCVA at baseline was identified as the most important prognostic indicator in all 3 groups. Additionally, DRT patients with a longer clinical course, higher CMT and central retinal vein occlusion (CRVO) tend to exhibit worse BCVA after treatment. In addition, CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion (BRVO) patients in CME group. SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.

CONCLUSION

The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups. Baseline parameters including clinical course, CMT, and RVO position are also useful in predicting the BCVA at different time points after treatment.

Optical Coherence Tomography Measurements in Type 1 Diabetic Subjects with Low and Moderate Daily Physical Activity

Background: Physical activity is nowadays recognized as a protective factor against cardiovascular conditions, being cost-effective and easy to implement. Through its positive effects on hemodynamic and oxidative stress, different intensities in daily physical activity could influence diabetic macular edema (DME) in type 1 Diabetes Mellitus (DM). Methods: With the help of a spectral domain optical coherence tomography (OCT) device, we studied the macular thickness and ETDRS map parameters in type 1 DM patients who were classified into two groups: low and moderate intensity routine physical activity status, using the international physical activity questionnaire (IPAQ). All subjects received comparable anti-VEGF treatment. Results: Having a long disease evolution, patients with type 1 DM (T1DM) with moderate physical activity displayed better OCT measurements in specific retinal sectors than their counterparts with low physical activity. Variables such as age and body mass index (BMI) can influence the level of physical activity in T1DM patients. Conclusions: This study showed a lower prevalence of DME in T1DM subjects with moderate physical activity levels, revealing lower values for ETDRS OCT parameters in specific retinal sectors. The macular volumes (mm3) were significantly lower in the right eye for this group of subjects. Abbreviations: BMI = body mass index, CMT = central macular thickness, DM = diabetes mellitus, DME = diabetic macular edema, DR = diabetic retinopathy, FT = foveal thickness, II = inferior inner thickness, IO = inferior outer thickness, IPAQ = international physical activity questionnaire, LE = left eye, OCT = optical coherence tomography, MMT = maximal macular thickness, mMT = minimal macular thickness, MV = macular volume, NI = nasal inner thickness, NO = nasal outer thickness, QoL = quality of life, RE = right eye, SI = superior inner thickness, SO = superior outer thickness, T1DM = type 1 diabetes mellitus, T2DM = type 2 diabetes mellitus, TI = temporal inner thickness, TO = temporal outer thickness.

Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study

BACKGROUND

To compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA).

METHODS

A cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings.

RESULTS

The study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels.

CONCLUSION

The morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.