External limiting membrane and ellipsoid zone structural integrity in diabetic macular edema

The external limiting membrane (ELM) and ellipsoid zone (EZ) can be observed exquisitely by SD-OCT. In diabetic macular edema (DME), dysfunction of mitochondria, represented by the EZ in the foveal photoreceptors results in reduced visual acuity (VA). An increase in VEGF was found to correlate with increased severity of DR, increased central subfield thickness (CST), and sequential disruption of ELM and EZ. The mechanism of ELM and EZ restoration after anti-VEGF therapy in DME has been discovered. The ELM restores first followed by EZ restoration. Thus, authors have discovered and established ELM as a novel retinal structural barrier.

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External limiting membrane: retinal structural barrier in diabetic macular edema

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00284-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Sandeep Saxena ◽

Levent Akduman ◽

Carsten H. Meyer

Keyword(s):

Optical Coherence Tomography ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Spectral Domain ◽

Optical Coherence ◽

Barrier Effect ◽

External Limiting Membrane ◽

Ellipsoid Zone ◽

Structural Barrier ◽

Sd Oct

AbstractAdvances in spectral-domain optical coherence tomography (SD-OCT) technology have enhanced the understanding of external limiting membrane (ELM) and ellipsoid zone (EZ) in diabetic macular edema. An increase in VEGF has been demonstrated to be associated with sequential ELM and EZ disruption on SD-OCT. An intact ELM is a prerequisite for an intact EZ in DME. Anti-VEGF therapy leads to restoration of barrier effect of ELM. The ELM restores first followed by EZ restoration.

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Ellipsoid Zone Integrity and Visual Acuity Changes during Diabetic Macular Edema Therapy: A Longitudinal Study

Journal of Diabetes Research ◽

10.1155/2021/8117650 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Lucy J. Kessler ◽

Gerd U. Auffarth ◽

Dmitrii Bagautdinov ◽

Ramin Khoramnia

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Visual Outcome ◽

Long Term Results ◽

First Year ◽

Ellipsoid Zone ◽

Anti Vegf ◽

Potential Biomarker

Purpose. Ellipsoid zone (EZ) integrity is identified as a potential biomarker for therapy surveillance and outcome prediction of visual acuity (VA). However, only a few studies report long-term results of over 1 year of clinical and anatomical changes in patients with diabetic macular edema (DME). This study is aimed at describing the long-term VA and anatomical outcomes in spectral domain optical coherence tomography (OCT) (relative ellipsoid zone reflectivity ratio, central macular thickness, and volume) in patients with DME treated with antivascular endothelial growth factor (anti-VEGF) therapy. Furthermore, we studied the correlation between EZ integrity and changes in visual acuity. Methods. 71 eyes of 71 patients were included in this retrospective study. Clinical characteristics were reviewed yearly. OCT data were assessed at baseline and after 1, 3, and 5 years. EZ parameters were quantified automatically. OCT parameters and visual outcome were correlated and analyzed in multivariable regression models. Results. EZ reflectivity ratio correlated with functional outcome in DME patients from baseline to fifth year at all time points (for all p < 0.05 ). EZ reflectivity improved the most in the first year of treatment (0.68 to 0.75; p < 0.05 ) and declined gradually until year 5 of therapy (0.71; compared to baseline p > 0.05 ). Similarly, best VA was achieved after 1 year (0.40 logarithm of the minimum angle of resolution (logMAR) to 0.28 logMAR; p < 0.001 ) and declined gradually until year 5. Final VA in year 5 was comparable to baseline (0.45 logMAR, compared to baseline p > 0.05 ). Together with baseline VA, baseline EZ parameters did predict VA outcome after 1 year ( p < 0.05 ). Concordantly, VA and EZ parameters from year 1 were associated with VA outcome in year 2. Conclusion. This study described the long-term course of EZ changes during anti-VEGF treatment in DME patients. In addition, our results underlined the potential of EZ parameters as novel OCT biomarkers for prediction of VA outcomes during therapy.

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Multifocal Electroretinogram, Central Macula Thickness and Visual Acuity in Diabetic Macular Edema Following Intravitreal Injection of anti-VEGF

International Journal of Retina ◽

10.35479/ijretina.2021.vol004.iss002.156 ◽

2021 ◽

Vol 4 (2) ◽

pp. 150

Author(s):

Syntia Nusanti ◽

Kirana Sampurna ◽

Ari Djatikusumo ◽

Anggun Rama Yudantha ◽

Joedo Prihartono

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Macular Edema ◽

Intravitreal Injection ◽

Diabetic Macular Edema ◽

Proliferative Diabetic Retinopathy ◽

Diabetic Patients ◽

Post Injection ◽

Anti Vegf ◽

Sd Oct

Introduction : Diabetic Retinopathy (DR) is one of the major cause of visual acuity deterioration in diabetic patients. The loss of central visual acuity in diabetic patients are mainly due to macula edema, which is found in 29% diabetic patients with the over 20 years duration of disease. The aim of this study is to evaluate and investigate the possible correlation among changes of visual acuity (VA), central macular thickness (CMT) using Spectral Domain Optical Coherence Tomography (SD-OCT). Electrophysiological responses using multifocal electroretinography (MfERG) in diabetic macular edema (DME) following intravitreal injection of bevacizumab. Methods: Single arm clinical trial. Thirty-three eyes of 33 DME patients (16 non-proliferative diabetic retinopathy and 17 non-high-risk proliferative diabetic retinopathy), receives intravitreal bevacizumab 1,25mg. All patients underwent complete ophthalmic examination including ETDRS VA testing, Sixty-one scaled hexagon MfERG and SD-OCT scan at baseline, 1-week and 1-month post-injection. Components of the first order kernel (N1, N2 and P1) in central 2o were measured. Result : MfERG showed reduced P1 amplitude (P<0.05) at 1-week after injection followed by increased P1 amplitude (P>0.05) at 1-month after treatment as compared to the baseline in all subjects. There was 19% improvement CMT and 0.2Logmar VA improvement in 1-month post-injection compared to the baseline (P<005). This study showed no serious ocular adverse effects. There was no significant correlation between changes in visual acuity with changes in CMT or other MfERG parameters. Conclusion: Intravitreal injection bevacizumab resulting in improved VA, reduction in CMT and mild improvement in the MfERG responses. Although VA changes did not correlate with reduced CMT nor with improved responses of MfERG, the combined use of SD-OCT and MfERG may be used to evaluate macular function in DME patient with worsened visual acuity post anti-VEGF injection.

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Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1051 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Muhammad Ali Haider ◽

Uzma Sattar ◽

Syeda Rushda Zaidi

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Macular Thickness ◽

Rank Test ◽

P Value ◽

Central Macular Thickness ◽

Anti Vegf ◽

Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

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Subthreshold micropulse laser versus intravitreal anti-VEGF for diabetic macular edema patients with relatively better visual acuity

International Journal of Ophthalmology ◽

10.18240/ijo.2020.10.15 ◽

2020 ◽

Vol 13 (10) ◽

pp. 1606-1611

Author(s):

Sezen Akkaya

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Micropulse Laser ◽

Anti Vegf ◽

Subthreshold Micropulse Laser

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Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

BioMed Research International ◽

10.1155/2018/8289253 ◽

2018 ◽

Vol 2018 ◽

pp. 1-16 ◽

Cited By ~ 9

Author(s):

Laurent Kodjikian ◽

David Bellocq ◽

Thibaud Mathis

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Observational Studies ◽

Real Life ◽

Pharmacological Management ◽

Anti Vegf ◽

Pubmed Database ◽

Baseline Visual Acuity

Objectives of the Study. Summary of observational studies concerning the pharmacological management of diabetic macular edema (DME). Methods. A literature review was conducted using the PubMed database on 1 February 2018 to identify studies evaluating the efficacy of anti-VEGF and dexamethasone (DEX) implants for DME. Studies with more than 10 patients and follow-up of more than 6 months were selected. Analyses were carried out on the overall population and on subgroups defined according to baseline visual acuity (BVA) and the patients’ naïve or non-naïve status. Results. Thirty-two studies evaluating the efficacy of anti-VEGF and 31 studies evaluating the efficacy of DEX-implants were retained, concerning 6,842 and 1,703 eyes, respectively. A mean gain of +4.7 letters for a mean of 5.8 injections (mean follow-up: 15.6 months) and +9.6 letters for a mean of 1.6 injections (10.3 months) was found in the anti-VEGF and DEX-implant studies, respectively. Final VA appears to be similar for both treatment (62 letters for anti-VEGF, 61.2 letters for DEX-implant), and BVA appears lower for DEX-implant, which may partially explain the greater visual gain. The DEX-implant studies show greater gains in VA compared to the anti-VEGF studies, especially for higher BVA. Indeed, mean gains for the subgroups of patients with BVA<50 letters, 50<BVA<60 letters, and BVA>60 letters are +4.3, +5.8, and +3.1 letters, respectively, in the anti-VEGF studies and +10.5, +9.3, and +8.8 letters, respectively, in the DEX-implant studies. Regarding the patient’s initial status, only naïve status appears to confer the best functional response in DEX-implant studies. Conclusion. Observational studies investigating DEX-implant report clinically similar final VA when compared to anti-VEGF, but superior visual gains in real-life practice. This latter difference could be due to the better BVA, but also to the fact that less injections were administered in the anti-VEGF observational studies than in the interventional studies.

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Rapid response to dexamethasone intravitreal implant in diabetic macular edema

European Journal of Ophthalmology ◽

10.5301/ejo.5000989 ◽

2017 ◽

Vol 28 (1) ◽

pp. 74-79 ◽

Cited By ~ 4

Author(s):

Giuseppe Lo Giudice ◽

Antonio Avarello ◽

Gianluca Campana ◽

Alessandro Galan

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Secondary Outcome ◽

Dexamethasone Intravitreal Implant ◽

Clinical Series ◽

Intravitreal Implant ◽

Early Effects ◽

Sd Oct

Purpose: To evaluate the early effects of dexamethasone (DEX) intravitreal implants in patients with diabetic macular edema (DME). Methods: This was a prospective, single-arm, interventional clinical series. Eighteen patients (18 eyes) with chronic/recalcitrant or naive DME were included. Patients underwent single DEX intravitreal implant. Clinical assessments, including ophthalmologic examination, central retinal thickness (CRT) measurement by spectral-domain optical coherence tomography (SD-OCT) scan, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were carried out at baseline, 1-3 hours, and then 3, 7, and 30 days after treatment. The main outcome was change in CRT on SD-OCT, while secondary outcome measures included visual acuity (VA) and changes in IOP following implant. Results: Mean CRT significantly decreased from 565 ± 171 µm at baseline to 310 ± 89 µm at end of follow-up (p<0.001), with reduction becoming evident 1-3 hours after injection. Mean BCVA also significantly improved 7 days and 30 days after treatment up to 0.14 logMAR (p<0.05). All patients had a controlled IOP after the injection with only 1/18 eyes having a transient increase in IOP during follow-up. Conclusions: This is the first study showing very early effects of DEX implants on CRT reduction and VA improvement in DME.

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Infrared reflectance image-guided laser photocoagulation of telangiectatic capillaries in persistent diabetic macular edema

Scientific Reports ◽

10.1038/s41598-021-01183-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hyeon Cheol Roh ◽

Chaeyeon Lee ◽

Se Woong Kang ◽

Kyung Jun Choi ◽

Jun Soo Eun ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Laser Photocoagulation ◽

Infrared Reflectance ◽

Closure Rate ◽

Image Guided ◽

Focal Laser Photocoagulation ◽

Central Subfield Thickness ◽

Persistent Diabetic Macular Edema

AbstractThis study aimed to assess detection rate of telangiectatic capillaries (TelCaps) with infrared reflectance (IR) and optical coherence tomography (OCT) images and to evaluate the clinical efficacy of IR image-guided focal laser photocoagulation of TelCaps in persistent diabetic macular edema (DME). This retrospective case series included 28 eyes of 28 patients with TelCap and persistent DME refractory to intravitreal anti-vascular endothelial growth factor or corticosteroids. The presence of TelCaps was confirmed using IR and OCT images. All patients were followed up for more than 12 months after direct focal laser photocoagulation of the TelCaps. The TelCap closure rate, changes in best-corrected visual acuity, and central subfield thickness were analyzed. On IR imaging, TelCap appeared as a characteristic hyperreflectivity within a hyporeflective spherical lesion in 85.7% of the eyes. After focal laser photocoagulation, the TelCap closure rate was 57.1% at 3 months and 71.4% at 12 months. A significant improvement in visual acuity and reduction in central subfield thickness were observed at three and 12 months after focal laser photocoagulation (all p < 0.05). The characteristic hyperreflectivity within hyporeflective lesions on the IR image in conjunction with OCT helps identify the TelCap. Our results suggest that IR imaging and OCT-guided focal laser photocoagulation of TelCaps can improve functional and anatomical outcomes in persistent DME.

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EFFECT OF ANTI-VEGF THERAPY ON THE STRUCTURAL STATE OF THE RETINA IN DIABETIC MACULAR EDEMA

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/23717 ◽

2016 ◽

Vol 1 (6) ◽

pp. 24-27

Author(s):

Бикбов ◽

Mukharram Bikbov ◽

Файзрахманов ◽

Rinat Fayzrakhmanov ◽

Зайнуллин ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Optical Density ◽

Structural State ◽

Central Area ◽

Macular Pigment ◽

Optical Coherence ◽

Macular Pigment Optical Density ◽

Anti Vegf

Objective: to analyze the structural state of the central area of the retina in diabetic macular edema in the background anti-VEGF therapy.Methods. The study included 38patients (40eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05ml. The results were analyzed after three intravitreal injections with 1month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical densityResults. Analyzing optical density of the macular pigment we revealed a significant increase of all parameters in 73% of patients after the therapy. The average value of the optical density before treatment was at 0.102±0.01du, on the background of anti-VEGF-therapy this figure went up to 0.213±0.01 (p<0.05). According to the optical coherence to-mography average retinal thickness before treatment made 404.62±15.23μm, after the treatment – 300.91±6.43μm (р<0,05). When comparing data of optical coherence tomography and macular pigment optical density we revealed more pronounced decrease in the macular pigment optical density in the area of the retinal edema and a significant increase in the basic parameters on the background of the therapy.Conclusion. Anti-VEGF-therapy significantly improves visual acuity, the recovery profile of macular edema and reduces the zone in patients with diabetic macular edema.

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Anti-VEGF agents in the treatment of diabetic macular edema

Diabetes Mellitus ◽

10.14341/dm2013478-84 ◽

2013 ◽

Vol 16 (4) ◽

pp. 78-84

Author(s):

Vladimir Iosifovich Konenkov ◽

Vadim Valerievich Klimontov ◽

Valeriy Vyacheslavovich Chernykh ◽

Nadezhda Viktorovna Tjan

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Randomized Clinical Trials ◽

Diabetic Patients ◽

Vegf Inhibitors ◽

Vascular Endothelium Growth Factor ◽

Future Studies ◽

Anti Vegf ◽

New Treatment

Diabetic macular edema (DME) is a common complication associated with the loss of visual acuity in diabetic patients. Intravitreal injections of vascular endothelium growth factor (VEGF) inhibitors (anti-VEGF therapy) have been proposed recently as a new treatment option for patients with DME. In this review we summarized results of randomized clinical trials of VEGF inhibitors in DME patients. The results indicate that all studied inhibitors (ranibizumab, bevacizumab, pegaptanib and aflibersept) reduce the retinal thickness and improve of visual acuity in DME when are used as a monotherapy or in combination with the laser treatment. Optimal course duration and effectiveness predictors of anti-VEGF therapy in DME should be elucidate in the future studies.

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