Effectiveness of microperimetry in evaluating anti-vascular endothelial growth factor therapy for diabetic macular edema patients with relatively good vision: A retrospective observational study

Abstract

No studies have evaluated the retinal sensitivity (RS) for diabetic macular edema (DME) patients with good vision. Therefore, this study aimed to determine the effectiveness of microperimetry in evaluating the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatment for DME patients with relatively good vision.Twenty-seven eyes of 27 patients (mean age, 61.3 ± 11.2 years) with DME and decimal best-corrected visual acuity (BCVA) ≥0.6 were studied. All patients received 3 consecutive monthly injections of intravitreal anti-VEGF agents. The BCVA, central subfield macular thickness (CMT), and RS were evaluated by microperimetry (MAIA) within the 10 degree of the foveal center. To determine significant differences between the values, we used paired t tests.Patients were evaluated at baseline and 4 weeks after the third injection. The BCVA improved significantly from 0.18 ± 0.06 logarithm of the minimum angle of resolution (logMAR) units to 0.13 ± 0.13 logMAR units (P = .002; paired t test). The CMT decreased significantly from 464.3 ± 91.8 μm to 393.4 ± 129.0 μm (P = .005), and the RS also improved significantly from 21.8 ± 3.1 dB to 24.1 ± 2.8 dB at 4 weeks after treatment (P = .006). Among the patients with a decimal BCVA of 0.7 or better at baseline, there was no significant improvement in the BCVA (P = .28). However, the CMT decreased significantly from 479.5 ± 79.1 μm to 394.0 ± 99.8 μm at 4 weeks after treatment (P = .007). The RS also improved significantly from 22.0 ± 2.4 dB to 24.0 ± 3.1 dB at 4 weeks after treatment (P = .004).Measuring RS by microperimetry is a good option for evaluating the effectiveness of anti-VEGF treatment for DME patients with a relatively good BCVA.

Figure 1

Case presentation. At the first visit, the BCVA of this patient had a decimal BCVA of 1.0 (20/20) with cystic DME (A). The CMT was 408 μm (B, shown as an OCT map), and the RS threshold was 24.4 dB (C, shown as a threshold map). Four weeks after three consecutive monthly injections of ranibizumab, the BCVA of the patient was a decimal BCVA of 1.0 (20/20) with a resolution of the cystic changes (D). The CMT of the patient was reduced to 265 μm (E), and the RS threshold was improved to 24.4 dB (F). Three months after treatment, the BCVA of the patient was 20/20 without recurrence of DME (G). The CMT of the patient improved to 260 μm (H), and the RS threshold of the patient improved to 26.3 dB (I). BCVA = best corrected visual acuity, CMT = central subfield macular thickness, DME = diabetic macular edema, OCT = optical coherence tomography, RS = retinal sensitivity.