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Evaluation of markers of outcome in real-world treatment of diabetic macular edema

Authors
  • Campos, António
  • Campos, Elisa J
  • do Carmo, Anália
  • Caramelo, Francisco
  • Martins, João
  • Sousa, João P
  • Ambrósio, António Francisco
  • Silva, Rufino
Type
Published Article
Journal
Eye and Vision
Publisher
BioMed Central
Publication Date
Oct 11, 2018
Volume
5
Issue
1
Identifiers
DOI: 10.1186/s40662-018-0119-9
Source
Springer Nature
Keywords
License
Green

Abstract

ObjectiveTo evaluate short-term markers of outcome in diabetic macular edema (DME).MethodsProspective interventional case series included 122 eyes of 122 patients with recently diagnosed DME. Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter. Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness (SFCT) and central retinal thickness (CRT). Anatomic (10% CRT decrease) and functional responses (best corrected visual acuity, BCVA gain ≥5 letters) were assessed at 3 months and 6 months using univariate and multivariate analyses. Parameters tested were gender, duration of diabetes, HbA1c, hypertension, CRT, SFCT, BCVA, ellipsoid zone (EZ) status, subfoveal neuroretinal detachment (SND), anti-VEGF used and laser naivety. A logistic regression model was applied to find independent markers outcome.ResultsBCVA increased, CRT and SFCT decreased at 3 months and 6 months. Good metabolic control (p = 0.003), intact baseline EZ (p = 0.030), EZ re-grading at 3 M (p < 0.001) and laser naivety (p = 0.001) were associated with better functional outcome. The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response, while lower baseline BCVA and intact EZ are predictors of functional response.ConclusionThe presence of SND predicts anatomic response only, while an intact EZ is critical to achieve a good functional outcome in DME.

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