Optical Coherence Tomography Biomarkers DROL, PROS, SND, Hyperreflective Walls of Foveal Cystoid Spaces As Predictors of Central Macular Thickness and Visual Acuity in Diabetic Macular Edema Treated with Intravitreal Ranibizumab

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2024 Apr 22

PMID 38648434

Authors

Ayushi Sardana

Kamaljeet Singh

Arti Singh

Vinod K Singh

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aims to establish DROL (disruption of retinal outer layers), PROS (photoreceptor outer segment length), SND (subfoveal neuroretinal detachment), and hyperreflective walls of foveal cystoid spaces (HRW) as optical coherence tomography (OCT) biomarkers and predictors of central macular thickness (CMT) and visual acuity in diabetic macular edema (DME) treated with intravitreal ranibizumab (IVR).

Methods: In this prospective, interventional study performed at a tertiary care center over a span of 1 year from December 2021 to December 2022, 50 eyes of 46 patients of DME were included. Visual acuity and spectral domain OCT imaging were performed at baseline. Using inbuilt calipers on SD-OCT, the horizontal extent of DROL and the vertical extent of PROS were measured manually. SND and HRW were assessed qualitatively. IVR was administered and patients were followed up at 4, 8, and 12 weeks.

Results: The eyes without DROL had statistically significant (P < 0.05) lesser CMT and better BCVA (best-corrected visual acuity) (P < 0.05) after pro re nata injection of IVR. There was a positive correlation between the extent of baseline DROL with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05), whereas negative correlation with the extent of baseline PROS with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05). The presence of HRW and SND predicted non-resolution of CMT and worse visual acuity after treatment with IVR in DME.

Conclusion: DROL, PROS, SND, and hyperreflective walls of foveal cystoid spaces may be utilized as qualitative as well as quantitative biomarkers to predict the post-treatment CMT and visual acuity in DME.

References

Eisma J, Dulle J, Fort P . Current knowledge on diabetic retinopathy from human donor tissues. World J Diabetes. 2015; 6(2):312-20. PMC: 4360424. DOI: 10.4239/wjd.v6.i2.312. View

Eraslan S, Yildirim O, Dursun O, Dinc E, Temel G . Relationship Between Final Visual Acuity and Optical Coherence Tomography Findings in Patients with Diabetic Macular Edema Undergoing Anti-VEGF Therapy. Turk J Ophthalmol. 2020; 50(3):163-168. PMC: 7338745. DOI: 10.4274/tjo.galenos.2019.91962. View

Maggio E, Sartore M, Attanasio M, Maraone G, Guerriero M, Polito A . Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in a Real-World Clinical Setting. Am J Ophthalmol. 2018; 195:209-222. DOI: 10.1016/j.ajo.2018.08.004. View

Murakami T, Yoshimura N . Structural changes in individual retinal layers in diabetic macular edema. J Diabetes Res. 2013; 2013:920713. PMC: 3773460. DOI: 10.1155/2013/920713. View

Otani T, Kishi S, Maruyama Y . Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999; 127(6):688-93. DOI: 10.1016/s0002-9394(99)00033-1. View

Cunha-Vaz J . Mechanisms of Retinal Fluid Accumulation and Blood-Retinal Barrier Breakdown. Dev Ophthalmol. 2017; 58:11-20. DOI: 10.1159/000455265. View

Vujosevic S, Cunha-Vaz J, Figueira J, Lowenstein A, Midena E, Parravano M . Standardization of Optical Coherence Tomography Angiography Imaging Biomarkers in Diabetic Retinal Disease. Ophthalmic Res. 2021; 64(6):871-887. DOI: 10.1159/000518620. View

Suciu C, Suciu V, Nicoara S . Optical Coherence Tomography (Angiography) Biomarkers in the Assessment and Monitoring of Diabetic Macular Edema. J Diabetes Res. 2021; 2020:6655021. PMC: 7790580. DOI: 10.1155/2020/6655021. View

Maden G, Cakir A, Icar D, Erden B, Bolukbasi S, Elcioglu M . The Distribution of the Photoreceptor Outer Segment Length in a Healthy Population. J Ophthalmol. 2018; 2017:4641902. PMC: 5749276. DOI: 10.1155/2017/4641902. View

10.

Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R . Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016; 2016:2156273. PMC: 5059543. DOI: 10.1155/2016/2156273. View

11.

Wan Zaki W, Abdul Mutalib H, Ramlan L, Hussain A, Mustapha A . Towards a Connected Mobile Cataract Screening System: A Future Approach. J Imaging. 2022; 8(2). PMC: 8879609. DOI: 10.3390/jimaging8020041. View

12.

Bemme S, Heins A, Lauermann P, Storch M, Khattab M, Hoerauf H . Reliability of Subjective Assessment of Spectral-Domain OCT Pathologic Features by Multiple Raters in Retinal Vein Occlusion. Ophthalmol Sci. 2022; 1(2):100031. PMC: 9562329. DOI: 10.1016/j.xops.2021.100031. View

13.

Murakami T, Suzuma K, Uji A, Yoshitake S, Dodo Y, Fujimoto M . Association between characteristics of foveal cystoid spaces and short-term responsiveness to ranibizumab for diabetic macular edema. Jpn J Ophthalmol. 2018; 62(3):292-301. DOI: 10.1007/s10384-018-0575-8. View

14.

Reichenbach A, Bringmann A . New functions of Müller cells. Glia. 2013; 61(5):651-78. DOI: 10.1002/glia.22477. View

15.

Roglic G, Varghese C, Thamarangsi T . Diabetes in South-East Asia: burden, gaps, challenges and ways forward. WHO South East Asia J Public Health. 2017; 5(1):1-4. DOI: 10.4103/2224-3151.206546. View

16.

Nguyen Q, Brown D, Marcus D, Boyer D, Patel S, Feiner L . Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012; 119(4):789-801. DOI: 10.1016/j.ophtha.2011.12.039. View

17.

Jian G, Jing X, Yang L, Lun L . Quantitative Analysis of Foveal Microvascular Differences in Diabetic Macular Edema with and without Subfoveal Neuroretinal Detachment. J Diabetes Res. 2020; 2020:2582690. PMC: 7063210. DOI: 10.1155/2020/2582690. View

18.

Ozkaya A, Alkin Z, Karakucuk Y, Karatas G, Fazil K, Gurkan Erdogan M . Thickness of the retinal photoreceptor outer segment layer in healthy volunteers and in patients with diabetes mellitus without retinopathy, diabetic retinopathy, or diabetic macular edema. Saudi J Ophthalmol. 2017; 31(2):69-75. PMC: 5436385. DOI: 10.1016/j.sjopt.2016.12.006. View

19.

De S, Saxena S, Kaur A, Mahdi A, Misra A, Singh M . Sequential restoration of external limiting membrane and ellipsoid zone after intravitreal anti-VEGF therapy in diabetic macular oedema. Eye (Lond). 2020; 35(5):1490-1495. PMC: 8182796. DOI: 10.1038/s41433-020-1100-0. View