DOES BASELINE SUB-FOVEAL CHORIODAL THICKNESS DETERMINES TREATMENT RESPONSE TO INTRAVITREAL AFLIBERCEPT IN DIABETIC MACULAR EDEMA?
Main Article Content
Abstract
Introduction: To determine the predictive value of baseline SFCT for response to treatment with serial intravitreal aflibercept injections for diabetic macular edema (DME).
Methods: A prospective multi-center study was done. Eyes with DME (n=95) were treated with intravitreal aflibercept injections q4week for first 5 doses, followed by 2mgq8week, respectively. SFCT and central macular thickness (CMT) were measured with serial enhanced depth imaging optical coherence tomography scans done at baseline and after the last injection. A functional responder was one with >5 ETDRS letter gain in vision. An anatomical responder was one with SFCT reduction>25u.
Results: At 6 months, after the last IV injection of aflibercept, the mean SFCT decreased significantly (319±47 at baseline, 250±36 at 6 months, P<0.001). A significantly higher baseline SFCT was seen in functional responders as compared to non-responders (329±50 versus 303±36u, independent t-test, P=0.002). Likewise, anatomical responders has a significantly higher baseline SFCT as compared to non-responders (327±51 versus 305±33, P=0.002). Multiple logistic regression (after adjusting for confounders like age, gender, duration of diabetes, and glycemic control, respectively) revealed that higher SFCT had increased odds of having a better functional (odds ratio=1.40, P=0.050) and anatomical outcome (odds ratio=1.23, P=0.001), respectively. The mean vision gain in functional responders and non-responders was 11and 5 ETDRS letters, respectively (P<0.001). The mean vision gain in anatomic responders and non-responders was 10 and 6 ETDRS letters, respectively (P<0.001).
Conclusion: SFCT at baseline predicts response to intravitreal aflibercept therapy in DME patients after adjusting for confounders. Eyes with a thicker baseline sub-foveal choroidal thickness had better anatomic and functional response at 9 months.
Keywords
Diabetic macular edema, aflibercept, sub-foveal choroidal thickness, ETDRS vision
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References
2. Kulkarni S, Kondalkar S, Mactaggart I, Shamanna BR, Lodhi A, Mendke R, et al. Estimating the magnitude of diabetes mellitus and diabetic retinopathy in an older age urban population in Pune, western India. BMJ Open Ophthalmol 2019;4: e000201.
3. International Diabetes Federation. Prevalence and magnitude of diabetes as per country/region[Internet].2015.Availablefrom: http://www.diabetesatlas.org/resources/2015-atlas.html. [Last accessed on 2023 June 20].
4. Executive Summary IFD Diabetes Atlas. 7th edition. [Accessed June 20, 2023]. Available from: http://www.diabetesatlas.org/
5. Pitcher JD 3rd, Moshfeghi AA, Lucas G, Boucher N, Moini H, Saroj N. Evaluation of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor for Diabetic Macular Edema in Clinical Practice in the United States. J Vitreoretin Dis. 2020; 5:108-113.
6. Sidorczuk P, Obuchowska I, Konopinska J, Dmuchowska DA. Correlation between Choroidal Vascularity Index and Outer Retina in Patients with Diabetic Retinopathy. J Clin Med. 2022; 11:3882.
7. Mohamed QA, Fletcher EC, Buckle M. Diabetic retinopathy: intravitreal vascular endothelial growth factor inhibitors for diabetic macular oedema. BMJ Clin Evid. 2016 Mar 16; 2016:0702.
8. Jiang J, Liu J, Yang J, Jiang B. Optical coherence tomography evaluation of choroidal structure changes in diabetic retinopathy patients: A systematic review and meta-analysis. Front Med (Lausanne). 2022; 9:986209.
9. Laíns I, Figueira J, Santos AR, Baltar A, Costa M, Nunes S, et al. Choroidal thickness in diabetic retinopathy: the influence of antiangiogenic therapy. Retina. 2014; 34:1199-207.
10. Querques G, Lattanzio R, Querques L, Del Turco C, Forte R, Pierro L, et al. Enhanced depth imaging optical coherence tomography in type 2 diabetes. Invest Ophthalmol Vis Sci. 2012; 53:6017-24.
11. Wu W, Gong Y, Hao H, Zhang J, Su P, Yan Q, et al. Choroidal layer segmentation in OCT images by a boundary enhancement network. Front Cell Dev Biol. 2022; 10:1060241.
12. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. ETDRS report number 7. Ophthalmology. 1991; 98:741-56.
13. Gregori NZ, Feuer W, Rosenfeld PJ. Novel method for analysing Snellen visual acuity measurements. Retina 2010; 30:1046–50.
14. Yang HS, Choi YJ, Han HY, Kim HS, Park SH, et al. The Relationship Between Retinal and Choroidal Thickness and Adiponectin Concentrations in Patients With Type 2 Diabetes Mellitus. Invest Ophthalmol Vis Sci. 2023; 64:6.
15. Okamoto M, Yamashita M, Ogata N. Effects of intravitreal injection of ranibizumab on choroidal structure and blood flow in eyes with diabetic macular edema. Graefes Arch Clin Exp Ophthalmol. 2018; 256:885-892.
16. Yiu G, Manjunath V, Chiu SJ, Farsiu S, Mahmoud TH. Effect of anti-vascular endothelial growth factor therapy on choroidal thickness in diabetic macular edema. Am J Ophthalmol. 2014; 158:745-751.e2.
17. Savur F, Kaldırım H, Atalay K, Korkmaz Ş. Changes in choroidal thickness after anti-vascular endothelial growth factor treatment of diabetic macular edema, real-life data, 2-year results. Cutan Ocul Toxicol. 2021; 40:326-331.
18. Rayess N, Rahimy E, Ying GS, Bagheri N, Ho AC, Regillo CD, et al. Baseline choroidal thickness as a predictor for response to anti-vascular endothelial growth factor therapy in diabetic macular edema. Am J Ophthalmol. 2015; 159:85-91. e1-3.
19. Kang HM, Kwon HJ, Yi JH, Lee CS, Lee SC. Sub-foveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration. Am J Ophthalmol 2014; 157:1013-1021.
20. Valentim CCS, Singh RP, Du W, Moini H, Talcott KE. Time to Resolution of Diabetic Macular Edema after Treatment with Intravitreal Aflibercept Injection or Laser in VISTA and VIVID. Ophthalmol Retina. 2023; 7:24-32.
21. Heier JS, Korobelnik JF, Brown DM, Schmidt-Erfurth U, Do DV, Midena E, et al. Intravitreal Aflibercept for Diabetic Macular Edema: 148-Week Results from the VISTA and VIVID Studies. Ophthalmology. 2016; 123:2376-2385.
22. Minami Y, Nagaoka T, Ishibazawa A, Yoshida A. Short-Term effect of intravitreal ranibizumab therapy on macular edema after branch retinal vein occlusion. Retina. 2016; 36:1726-32.
23. Ebneter A, Wolf S, Zinkernagel MS. Prognostic significance of foveal capillary drop-out and previous panretinal photocoagulation for diabetic macular oedema treated with ranibizumab. Br J Ophthalmol.2016;100:365–70.
24. Korobelnik JF, Do DV, Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology.2014;121:2247–54.