Preliminary Report on Optical Coherence Tomography Angiography Biomarkers in Non-Responders and Responders to Intravitreal Anti-VEGF Injection for Diabetic Macular Oedema

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2023 May 27

PMID 37238219

Authors

Sanjana Chouhan

Rekha Priya Kalluri Bharat

Janani Surya

Sashwanthi Mohan

Janarthanam Jothi Balaji

V K Viekash

Vasudevan Lakshminarayanan

Rajiv Raman

Affiliations

Soon will be listed here.

Abstract

Purpose: To identify optical coherence tomography angiography (OCTA) biomarkers in patients who were treated for diabetic macular oedema (DME) with intravitreal anti-vascular endothelial growth factor (VEGF) injections and compare the OCTA parameters between responders and non-responders.

Methods: A retrospective cohort study of 61 eyes with DME who received at least one intravitreal anti-VEGF injection was included between July 2017 and October 2020. The subjects underwent a comprehensive eye examination followed by an OCTA examination before and after intravitreal anti-VEGF injection. Demographic data, visual acuity, and OCTA parameters were documented, and further analysis was performed pre- and post-intravitreal anti-VEGF injection.

Results: Out of 61 eyes which underwent intravitreal anti-VEGF injection for diabetic macular oedema, 30 were responders (group 1) and 31 were non-responders (group 2). We found that the responders (group 1) had a higher vessel density in the outer ring that was statistically significant ( = 0.022), and higher perfusion density was noted in the outer ring ( = 0.012) and full ring ( = 0.044) at levels of the superficial capillary plexus (SCP). We also observed a lower vessel diameter index in the deep capillary plexus (DCP) in responders when compared to non-responders ( < 0.00).

Conclusion: The evaluation of SCP in OCTA in addition to DCP can result in a better prediction of treatment response and early management in diabetic macular oedema.

Citing Articles

Predictive value of optical coherence tomography angiography in management of diabetic macular edema.

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References

Trucco E, Azegrouz H, Dhillon B . Modeling the tortuosity of retinal vessels: does caliber play a role?. IEEE Trans Biomed Eng. 2010; 57(9):2239-47. DOI: 10.1109/TBME.2010.2050771. View

Viekash V, Jothi Balaji J, Lakshminarayanan V . FAZSeg: A New Software for Quantification of the Foveal Avascular Zone. Clin Ophthalmol. 2022; 15:4817-4827. PMC: 8714006. DOI: 10.2147/OPTH.S346145. View

Nesper P, Roberts P, Onishi A, Chai H, Liu L, Jampol L . Quantifying Microvascular Abnormalities With Increasing Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci. 2017; 58(6):BIO307-BIO315. PMC: 5693005. DOI: 10.1167/iovs.17-21787. View

Romero-Aroca P . Targeting the pathophysiology of diabetic macular edema. Diabetes Care. 2010; 33(11):2484-5. PMC: 2963519. DOI: 10.2337/dc10-1580. View

Kim A, Chu Z, Shahidzadeh A, Wang R, Puliafito C, Kashani A . Quantifying Microvascular Density and Morphology in Diabetic Retinopathy Using Spectral-Domain Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci. 2016; 57(9):OCT362-70. PMC: 4968771. DOI: 10.1167/iovs.15-18904. View

Hsieh Y, Alam M, Le D, Hsiao C, Yang C, Chao D . OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina. 2019; 3(10):826-834. PMC: 6921516. DOI: 10.1016/j.oret.2019.04.027. View

Hartnett M, Martiniuk D, Byfield G, Geisen P, Zeng G, Bautch V . Neutralizing VEGF decreases tortuosity and alters endothelial cell division orientation in arterioles and veins in a rat model of ROP: relevance to plus disease. Invest Ophthalmol Vis Sci. 2008; 49(7):3107-14. PMC: 2459334. DOI: 10.1167/iovs.08-1780. View

Weiler D, Engelke C, Moore A, Harrison W . Arteriole tortuosity associated with diabetic retinopathy and cholesterol. Optom Vis Sci. 2014; 92(3):384-91. DOI: 10.1097/OPX.0000000000000484. View

Tang F, Chan E, Sun Z, Wong R, Lok J, Szeto S . Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes. Eye Vis (Lond). 2020; 7:7. PMC: 6996172. DOI: 10.1186/s40662-019-0173-y. View

10.

Choi J, Kwon J, Shin J, Lee J, Lee S, Kook M . Quantitative optical coherence tomography angiography of macular vascular structure and foveal avascular zone in glaucoma. PLoS One. 2017; 12(9):e0184948. PMC: 5608222. DOI: 10.1371/journal.pone.0184948. View

11.

AttaAllah H, Mohamed A, Ali M . Macular vessels density in diabetic retinopathy: quantitative assessment using optical coherence tomography angiography. Int Ophthalmol. 2018; 39(8):1845-1859. DOI: 10.1007/s10792-018-1013-0. View

12.

Parravano M, De Geronimo D, Scarinci F, Virgili G, Querques L, Varano M . Progression of Diabetic Microaneurysms According to the Internal Reflectivity on Structural Optical Coherence Tomography and Visibility on Optical Coherence Tomography Angiography. Am J Ophthalmol. 2018; 198:8-16. DOI: 10.1016/j.ajo.2018.09.031. View

13.

Sang D, DAmore P . Is blockade of vascular endothelial growth factor beneficial for all types of diabetic retinopathy?. Diabetologia. 2008; 51(9):1570-3. PMC: 8244844. DOI: 10.1007/s00125-008-1078-9. View

14.

Bresnick G, Condit R, Syrjala S, Palta M, Groo A, Korth K . Abnormalities of the foveal avascular zone in diabetic retinopathy. Arch Ophthalmol. 1984; 102(9):1286-93. DOI: 10.1001/archopht.1984.01040031036019. View

15.

Veiby N, Simeunovic A, Heier M, Brunborg C, Saddique N, Moe M . Associations between Macular OCT Angiography and Nonproliferative Diabetic Retinopathy in Young Patients with Type 1 Diabetes Mellitus. J Diabetes Res. 2020; 2020:8849116. PMC: 7721511. DOI: 10.1155/2020/8849116. View

16.

Busch C, Wakabayashi T, Sato T, Fukushima Y, Hara C, Shiraki N . Retinal Microvasculature and Visual Acuity after Intravitreal Aflibercept in Diabetic Macular Edema: An Optical Coherence Tomography Angiography Study. Sci Rep. 2019; 9(1):1561. PMC: 6367399. DOI: 10.1038/s41598-018-38248-1. View

17.

Lee J, Moon B, Cho A, Yoon Y . Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response. Ophthalmology. 2016; 123(11):2368-2375. DOI: 10.1016/j.ophtha.2016.07.010. View

18.

Sasongko M, Wong T, Nguyen T, Cheung C, Shaw J, Wang J . Retinal vascular tortuosity in persons with diabetes and diabetic retinopathy. Diabetologia. 2011; 54(9):2409-16. DOI: 10.1007/s00125-011-2200-y. View

19.

Cheong K, Lee S, Ang M, Teo K . Vessel Density Changes on Optical Coherence Tomography Angiography after Vascular Endothelial Growth Factor Inhibitor Treatment for Diabetic Macular Edema. Turk J Ophthalmol. 2021; 50(6):343-350. PMC: 7802092. DOI: 10.4274/tjo.galenos.2020.81592. View

20.

Durbin M, An L, Shemonski N, Soares M, Santos T, Lopes M . Quantification of Retinal Microvascular Density in Optical Coherence Tomographic Angiography Images in Diabetic Retinopathy. JAMA Ophthalmol. 2017; 135(4):370-376. PMC: 5470403. DOI: 10.1001/jamaophthalmol.2017.0080. View