Correlation of Volume of Macular Edema with Retinal Tomography Features in Diabetic Retinopathy Eyes

Optical coherence tomography (OCT) enables the detection of macular edema, a significant pathological outcome of diabetic retinopathy (DR). The aim of the study was to correlate edema volume with the severity of diabetic retinopathy and response to treatment with intravitreal injections (compared to baseline). Diabetic retinopathy (DR; n = 181) eyes were imaged with OCT (Heidelberg Engineering, Germany). They were grouped as responders (a decrease in thickness after intravitreal injection of Bevacizumab), non-responders (persistent edema or reduced decrease in thickness), recurrent (recurrence of edema after injection), and treatment naïve (no change in edema at follow-up without any injection). The post-treatment imaging of eyes was included for all groups, except for the treatment naïve group. All eyes underwent a 9 × 6 mm raster scan to measure the edema volume (EV). Central foveal thickness (CFT), central foveal volume (CFV), and total retinal volume (TRV) were obtained from the early treatment diabetic retinopathy study (ETDRS) map. The median EV increased with DR severity, with PDR having the greatest EV (4.01 mm3). This correlated positively with TRV (p < 0.001). Median CFV and CFT were the greatest in severe NPDR. Median EV was the greatest in the recurrent eyes (4.675 mm3) and lowest (1.6 mm3) in the treatment naïve group. Responders and non-responders groups had median values of 3.65 and 3.93 mm3, respectively. This trend was not observed with CFV, CFT, and TRV. A linear regression yielded threshold values of CFV (~0.3 mm3), CFT (~386 µm), and TRV (~9.06 mm3), above which EV may be detected by the current scanner. In this study, EV provided a better distinction between the response groups when compared to retinal tomography parameters. The EV increased with disease severity. Thus, EV can be a more precise parameter to identify subclinical edema and aid in better treatment planning.

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Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

Journal of International Medical Research ◽

10.1177/0300060520985369 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098536

Author(s):

Yuan Tao ◽

Pengfei Jiang ◽

Min Liu ◽

Ying Liu ◽

Lihua Song ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Intravitreal Injection ◽

Proliferative Diabetic Retinopathy ◽

Posterior Pole ◽

Foveal Thickness ◽

Hard Exudates ◽

Central Foveal Thickness ◽

Treatment Naïve ◽

The Mean ◽

Retinal Microaneurysms

Objective To evaluate whether diabetic retinopathy can be reversed after aflibercept, based on improvements in diabetic macular edema, hard exudates (HEs) of the posterior pole, and retinal microaneurysms (MAs). Methods This was a single-center retrospective study of 30 patients (34 eyes) with severe non-proliferative diabetic retinopathy (NPDR) who were treated between August and October 2018. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), area of HEs, and number of MAs were compared before and after treatment. Results The mean patient age was 61.4 ± 7.1 years; 14 patients (46.7%) were men. The mean number of injections per patient was 3.5 ± 0.5. The time between the last injection and the last follow-up was 82 days (range, 78–110 days). Six months after the first intravitreal injection, significant improvement was observed in BCVA (from 0.70 ± 0.18 to 0.42 ± 0.19 logMAR), CFT (from 377.17 ± 60.41 to 261.21 ± 31.50 µm), and number of MAs (from 182.2 ± 77.4 to 101.5 ± 59.6). Observations over 6 months after the first intravitreal injection showed a statistically significant reduction in the area of HEs (P = 0.007). No adverse events occurred during the treatment period. Conclusion Diabetic retinopathy might be partially reversed by aflibercept treatment, as indicated by BCVA, CFT, number of MAs, and area of HEs.

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Differentiating features of OCT angiography in diabetic macular edema

Scientific Reports ◽

10.1038/s41598-021-02859-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Reza Mirshahi ◽

Hamid Riazi-Esfahani ◽

Elias Khalili Pour ◽

Kaveh Fadakar ◽

Parsa Yarmohamadi ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Optical Coherence Tomography Angiography ◽

Vascular Density ◽

Diabetic Patients ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Capillary Plexus ◽

Superficial Capillary Plexus

AbstractThe purpose of current study was to evaluate different optical coherence tomography angiography (OCTA) metrics in eyes with diabetic retinopathy with and without diabetic macular edema (DME). In this retrospective study, macular OCTA images of eyes with non-proliferative or proliferative diabetic retinopathy were evaluated. Vascular density, vascular complexity and non-perfusion densities were compared between eyes with and without DME. One-hundred-thirty-eight eyes of 92 diabetic patients including 49 eyes with DME were included. In multivariate analysis, the presence of DME was positively associated with geometric perfusion deficit (GPD) in superficial capillary plexus (SCP), capillary non-perfusion (CNP) of SCP, and GPD in deep capillary plexus (DCP) (all P < 0.05). In eyes with DME, central foveal thickness was associated with VD ratio (SCP/DCP) (P = 0.001) and FAZ area (P = 0.001). In conclusion, in eyes with diabetic retinopathy, the presence of DME was associated with more extensive capillary non-perfusion compared to those with no macular edema.

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RaScaL: A Pilot Study to Assess the Efficacy, Durability, and Safety of a Single Intervention with Ranibizumab plus Peripheral Laser for Diabetic Macular Edema Associated with Peripheral Nonperfusion on Ultrawide-Field Fluorescein Angiography

Ophthalmologica ◽

10.1159/000367902 ◽

2014 ◽

Vol 233 (2) ◽

pp. 89-95 ◽

Cited By ~ 3

Author(s):

Ivan J. Suñer ◽

Marc C. Peden ◽

Mark E. Hammer ◽

W. Sanderson Grizzard ◽

Janet Traynom ◽

...

Keyword(s):

Pilot Study ◽

Fluorescein Angiography ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Ranibizumab ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Treatment Naïve ◽

Prospective Phase ◽

Single Intervention

Background and Objectives: To determine the efficacy, durability, and safety of a single treatment with intravitreal ranibizumab plus peripheral scatter laser (RaScaL) in patients with diabetic macular edema associated with peripheral retinal nonperfusion on ultrawide-field fluorescein angiography (UWFA). Study Design: A 6-month, randomized, controlled, prospective phase I/II study of 30 treatment-naïve eyes of 22 patients (8 bilateral patients) with visual impairment secondary to diabetic macular edema associated with peripheral nonperfusion on UWFA. Patients were randomized to receive ranibizumab plus UWFA-guided peripheral scatter laser (n = 15) or triamcinolone acetonide plus macular laser (n = 15). Results: At 6 months, the RaScaL group patients had fewer recurrences warranting retreatment (33% vs. 80%, p < 0.003). Mean change in final visual acuity and central foveal thickness were not statistically significant between groups. Conclusion: This pilot study suggests the efficacy, safety and durability of the RaScaL treatment regimen in patients with diabetic macular edema associated with peripheral nonperfusion on UWFA.

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Twelve-Month Results of a Single or Multiple Dexamethasone Intravitreal Implant for Macular Edema following Uncomplicated Phacoemulsification

BioMed Research International ◽

10.1155/2015/362564 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Solmaz Abdolrahimzadeh ◽

Vito Fenicia ◽

Maurizio Maurizi Enrici ◽

Pasquale Plateroti ◽

Dora Cianfrone ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Topical Therapy ◽

Mean Value ◽

Ophthalmological Examination ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

The clinical efficacy of one or two intravitreal injections of a continued deliverance dexamethasone 700 μg implant in ten patients with persistent macular edema following uncomplicated phacoemulsification was evaluated. Complete ophthalmological examination and spectral domain optical coherence tomography were carried out. Follow-up was at day 7 and months 1, 2, 4, 6, 8, and 12. At baseline mean best corrected visual acuity was 62 Early Treatment Diabetic Retinopathy Study Chart letters, which showed statistically significant improvement at each follow-up, except at month 6, to reach 79 letters at month 12 (P=0.018). Prior to treatment mean central foveal thickness was 622 μm, which showed statistically significant improvement at each follow-up to reach a mean value of 282 μm (P=0.012) at month 12. Five patients received a second dexamethasone implant at month 7. Two patients were excluded from the study at months 4 and 8. Intraocular pressure remained stable during the study period with the exception of mild increase in two patients requiring topical therapy. In conclusion there was statistically significant improvement of best corrected visual acuity and mean central foveal thickness with one or two intravitreal dexamethasone implants over 12 months.

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Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

PLoS ONE ◽

10.1371/journal.pone.0257695 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257695

Author(s):

Francesco Saverio Sorrentino ◽

Claudio Bonifazzi ◽

Francesco Parmeggiani

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Intravitreal Injection ◽

Triamcinolone Acetonide ◽

Diabetic Macular Edema ◽

Foveal Thickness ◽

Intravitreal Triamcinolone ◽

Central Foveal Thickness ◽

Preservative Free

Purpose To suggest the safety and efficacy of preservative-free triamcinolone acetonide intravitreal injectable suspension (Taioftal) for the treatment of diabetic macular edema. Methods A prospective clinical study involved 49 patients (49 eyes), that were treated with Taioftal and followed-up for six months. Complete ophthalmic examination, including spectral domain optical coherence tomography, was performed at baseline, and at month 1, 3, 6 after the intravitreal injection. Accurate collection and analysis of best-corrected visual acuity (BCVA), central foveal thickness (CFT), intraocular pressure (IOP), and adverse events (AEs) were carried out in order to evaluate visual function and macular morphology before and after treatment Results Median BCVA value chosen as comparing statistics was significantly improved at every follow-up time points (gain of 6 letters at month 1, 12 at month 3 –improvement up to 24% at month 3 with stabilization until month 6) compared to baseline, as certified by Kruskal-Wallis rank sum test (P<0.05). Median CFT significantly waned at each follow-up times (decrease of about 65 μm at month 1, 155 at month 3 –reduction up to 28% at month 3 keeping good outcome until month 6) compared to baseline (P<0.05). IOP elevation, with no severe increases, was the most common among spotted AEs (median of 23 mmHg at month 1, 20 at month 3). Conclusion Intravitreal injection of preservative-free triamcinolone (Taioftal) is an effective, safe and inexpensive drug used to improve visual acuity and reduce central foveal thickness in eyes affected by diabetic macular edema during an average time of 6 months. Temporary, never severe, elevation of IOP is totally manageable with topical medications. No serious vision-threatening complications are related to the use of intravitreal triamcinolone injections.

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Latent Diabetic Macular Edema in Chinese Diabetic Retinopathy Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.739656 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xue Bai ◽

Rui Hua

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Foveal Thickness ◽

Detection Rates ◽

Central Foveal Thickness ◽

Clinically Significant Macular Edema ◽

Color Fundus Images ◽

Vitreomacular Interface ◽

Clinically Significant

Purpose: To compare the detection rates of optical coherence tomography (OCT) and fluorescein angiography (FA) in a diabetic macular edema (DME) and the severity of diabetic retinopathy in both color fundus images (CFI) and FA, and to investigate the predictive factors in macular leakages in FA.Methods: This was a retrospective study, and a total of 132 eyes of 77 patients with diabetic retinopathy were enrolled. Macular OCT, FA, and CFI were reviewed and measured. Central foveal thickness was also measured.Results: The severity of diabetic retinopathy in FA was significantly higher than that in CFI (p < 0.001). OCT detected 26 eyes with DMEs, which included the following: 13 eyes with cystoid macular edemas; 13 eyes with serous retinal detachments; 11 eyes with diffuse retinal thickening; 4 eyes with vitreomacular interface abnormalities. In contrast, 72 out of 132 eyes (54.5%) showed macular leakages in FA, which was significantly higher than that detected by OCT (p < 0.001). Compared with FA, the sensitivity and the specificity of OCT in detecting DMEs were 30.6 and 93.3%, respectively. However, central foveal thickness was not significantly different between the patients with non-clinically significant macular edema (CSME, 253.1 ± 26.95 μm) and slight CSME (270.9 ± 37.11 μm, p = 0.204). The mean central foveal thickness in diabetic macular edema (FA) eyes was 271.8 ± 66.02 μm, which was significantly higher than that (253. ± 25.21 μm) in non-DME (FA) eyes (p = 0.039). The central foveal thickness in DME (FA) eyes was significantly lower than that in eyes with DME (OCT) (p = 0.014). After adjusting for age and sex, a logistic regression analysis showed that the classification of diabetic retinopathy in FA was positively associated with macular leakage in FA (p < 0.001).Conclusions: The severity of diabetic retinopathy is underestimated in CFI compared with that in FA. FA can detect latent DMEs, which appeared normal on OCT. The central foveal thickness is not a sensitive parameter for detecting latent DMEs.

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Analysis of quantitative correlations between microaneurysm, ischaemic index and new vessels in ultrawide-field fluorescein angiography images using automated software

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313596 ◽

2019 ◽

pp. bjophthalmol-2018-313596 ◽

Cited By ~ 2

Author(s):

Gisung Son ◽

Yoon Jeon Kim ◽

Yu Sub Sung ◽

Bumwoo Park ◽

June-Gone Kim

Keyword(s):

Diabetic Retinopathy ◽

Fluorescein Angiography ◽

Proliferative Diabetic Retinopathy ◽

Diabetic Macular Oedema ◽

Posterior Pole ◽

Peripheral Retina ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Treatment Naïve ◽

Automated Software

Background/AimTo analyse ultrawide-field fluorescein angiography (UWF-FA) images of diabetic retinopathy using a novel software that automatically calculates microaneurysm (MA) and non-perfusion area.MethodsTwo hundred UWF-FA images of treatment-naïve diabetic retinopathy (38 proliferative diabetic retinopathy and 162 non-proliferative diabetic retinopathy) from 120 patients (mean age 54.22; 80 male) were analysed using novel software to determine the number of MAs, area of capillary non-perfusion (ischaemic index) and number of neovascularisations. Each result was compared according to its retinal regions.ResultsFor the total retina, the mean number of MAs was 292.02 (±175.57) and the ischaemic index was 59.42% (±14.78%). Most MAs were located in the mid-peripheral retina (80.54%); however, the density of MAs was highest in the posterior pole (p<0.001). The ischaemic index was highest in the peripheral retina (89.19%), followed by mid-periphery (50.65%) and posterior pole (1.85%). Patients with diabetic macular oedema (DME) presented more MA and a greater ischaemic index (p<0.001, each) than those without DME.ConclusionThe automated software allowed prompt and quantitative analysis of UWF-FA images of DMR. MAs were most frequent in the nasal and mid-peripheral retina, with their density being highest in the posterior pole and nasal retina. Ischaemic index increased with distance from the posterior pole, showing strong correlation with central foveal thickness in all retinal areas except the posterior pole.

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Switch of Intravitreal Therapy for Macular Edema Secondary to Retinal Vein Occlusion from Anti-VEGF to Dexamethasone Implant and Vice Versa

Journal of Ophthalmology ◽

10.1155/2017/5831682 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Amelie Pielen ◽

Anima Desiree Bühler ◽

Sonja Ute Heinzelmann ◽

Daniel Böhringer ◽

Thomas Ness ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Dexamethasone Implant ◽

Intravitreal Therapy ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Vein Occlusion ◽

Anti Vegf ◽

Treatment Naïve ◽

Intravitreal Dexamethasone

Purpose. To evaluate the anatomical and functional outcome of intravitreal dexamethasone implant for macular edema secondary to central (C) or branch (B) retinal vein occlusion (RVO) in patients with persistent macular edema (ME) refractory to intravitreal antivascular endothelial growth factor (VEGF) treatment compared to treatment naïve patients and to dexamethasone-refractory eyes switched to anti-VEGF. Methods. Retrospective, observational study including 30 eyes previously treated with anti-VEGF (8 CRVO, 22 BRVO, mean age 69 ± 10 yrs), compared to 11 treatment naïve eyes (6 CRVO, 5 BRVO, 73 ± 11 yrs) and compared to dexamethasone nonresponders (2 CRVO, 4 BRVO, 69 ± 12). Outcome parameters were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by spectral-domain optical coherence tomography. Results. Mean BCVA improvement after switch to dexamethasone implant was 4 letters (p=0.08), and treatment naïve eyes gained 10 letters (p=0.66), while we noted no change in eyes after switch to anti-VEGF (p=0.74). Median CFT decrease was most pronounced in treatment naïve patients (−437 μm, p=0.002) compared to anti-VEGF refractory eyes (−170 μm, p=0.003) and dexamethasone-refractory eyes (−157, p=0.31). Conclusions. Dexamethasone significantly reduced ME secondary to RVO refractory to anti-VEGF. Functional gain was limited compared to treatment naïve eyes, probably due to worse BCVA and CFT at baseline in treatment naïve eyes.

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Efficacy of intravitreal ziv-aflibercept in patients with macular edema following retinal vein occlusion in Korle-Bu Teaching Hospital, Ghana: a retrospective case series

International Ophthalmology ◽

10.1007/s10792-021-01799-w ◽

2021 ◽

Author(s):

Imoro Zeba Braimah ◽

Kofi Agyabeng ◽

Winfried M. Amoaku

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Open Angle Glaucoma ◽

Case Series ◽

Retrospective Case ◽

Foveal Thickness ◽

Vein Occlusion ◽

Treatment Naïve

Abstract Aim To evaluate the efficacy of ziv-aflibercept in Ghanaian patients with macular edema (ME) secondary to retinal vein occlusion (RVO). Methodology In this retrospective study, the medical records of patients with ME secondary to RVO who had been treated with intravitreal ziv-aflibercept (IVZ) (1.25 mg/0.05 ml), as part of routine clinical practice, on pro re nata basis with a minimum follow-up of 6 months were retrieved and analyzed. The main outcome measures are mean change in best-corrected visual acuity (BCVA) and central subfield foveal thickness (CSFT) measured on optical coherence tomography from baseline to 12 months post-IVZ, and ocular and systemic safety. Results Forty-three eyes were included in this study. Their mean age was 62.8 ± 11.9 years, 67.4% had at least 12-month duration of follow-up, 50% had primary open-angle glaucoma and 38 (88.4%) eyes were treatment naive. There was significant improvement in mean BCVA in LogMAR at 1 month post-initiation of IVZ (0.8 ± 0.5 vs. 1.1 ± 0.6), and visual improvement was maintained up to 12 months (p < 0.001). Eyes with ME following BRVO had better mean BCVA at baseline and on subsequent visits compared to eyes with CRVO/HRVO (p = 0.01). There was significant reduction in mean CSFT up to 12 months post-IVZ injection compared to baseline (p < 0.001). Ocular complications observed were consistent with complications associated with RVO. Conclusion We have observed significant improvement in functional and anatomic outcomes 12 months post-initiation of IVZ. There is the need to confirm long-term efficacy and safety of IVZ in a large prospective study.

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One-year real-life results on effect of intravitreal aflibercept in patients with diabetic macular oedema switched from ranibizumab

European Journal of Ophthalmology ◽

10.1177/1120672120927275 ◽

2020 ◽

pp. 112067212092727

Author(s):

Marko Lukic ◽

Gwyn Williams ◽

Zaid Shalchi ◽

Praveen J Patel ◽

Philip G Hykin ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Early Treatment ◽

Macular Oedema ◽

Real Life ◽

Diabetic Macular Oedema ◽

Foveal Thickness ◽

Macular Volume ◽

Central Foveal Thickness ◽

The Mean

Purpose To assess visual and optical coherence tomography–derived anatomical outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in patients switched from intravitreal ranibizumab (Lucentis®). Design Retrospective, cohort study. Participants Ninety eyes (of 67 patients) receiving intravitreal anti–vascular endothelial growth factor therapy were included. Methods This is a retrospective, real-life, cohort study. Each patient had visual acuity measurements and optical coherence tomography scans performed at baseline and 12 months after the first injection of aflibercept was given. Main Outcome Measures We measured visual acuities in Early Treatment Diabetic Retinopathy Study letters, central foveal thickness and macular volume at baseline and at 12 months after the first aflibercept injection was given. Results Ninety switched eyes were included in this study. The mean (standard deviation) visual acuity was 63 (15.78) Early Treatment Diabetic Retinopathy Study letters. At baseline, the mean (standard deviation) central foveal thickness was 417.7 (158.4) μm and the mean macular volume was 9.96 (2.44) mm3. Mean change in visual acuity was +4 Early Treatment Diabetic Retinopathy Study letters (p = 0.0053). The mean change in macular volume was −1.53 mm 3 in SW group (p = 0.21), while the change in central foveal thickness was −136.8 μm (p = 0.69). Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in the switched group at 12 months after commencing treatment with aflibercept for diabetic macular oedema.

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