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. 2024 Dec 27;24(1):551.
doi: 10.1186/s12886-024-03744-8.

Early response of anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) management: microperimetry and optical coherence tomography (OCT) findings: a pilot study at national eye center of third world country

Grimaldi Ihsan  1   2 , Ameliza Kwartika  3 , Made Indra Widyanatha  4   5 , Rova Virgana  4   5 , Erwin Iskandar  4   5 , Arief Sjamsulaksan Kartasasmita  4   5
Affiliations

Early response of anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) management: microperimetry and optical coherence tomography (OCT) findings: a pilot study at national eye center of third world country

Grimaldi Ihsan et al. BMC Ophthalmol. .

Abstract

Purpose: To evaluate early response of retinal sensitivity (RS) and retinal morphology in diabetic macular edema (DME) patients after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.

Methods: Sixteen eyes of 12 DME patients were included in this study conducted prospectively. All eyes underwent functional and morphologic examination of the macular area using microperimetry and optical coherence tomography (OCT) before and after intravitreal anti-VEGF injection. To determine significant differences between the values, paired t test was used. A correlation between CMT and RS was made using Spearman's test.

Results: Patients were evaluated at baseline, one week and one month after injection. The central macular thickness (CMT) decreased significantly from 449.33 ± 100.79 μm to 427.94 ± 85.76 μm to 357.93 ± 75.92 μm. The RS improved significantly from 7.94 ± 6.43 dB to 11.09 ± 7.42 dB at one week and to 14.22 ± 7.66 dB at one month after treatment. The CMT was significant negatively correlated to RS (r=-0.259, p = < 0.001), with decay of 0.025 dB for every 1 μm increase of CMT.

Conclusions: Retinal thickening due to DME can be adequately quantified using OCT, while microperimetry can offer information about retinal sensitivity in the exact location. Therefore, microperimetry can be a useful tool in predicting the functional outcome and determining the efficacy of anti-VEGF treatment for DME patients.

Keywords: Anti-VEGF response; Diabetic macular edema; Macular thickness; Microperimetry; Optical coherence tomography (OCT); Retinal sensitivity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: No names, personal identification numbers, home addresses, contact information, photographs, or any other data that could be traced back to individual patients were collected. Further, no tissue specimens were analyzed in the project. Ethics approval and consent to participate that this study was approved by “Komite Etik Pusat Mata Nasional Rumah Sakit Cicendo” ethics committee. The requirement for informed consent was waived by “Komite Etik Pusat Mata Nasional Rumah Sakit Mata Cicendo” considering that the study used no sensitive patient information; did not entail any treatment, other interventions, tests, examinations, or interviews; did not affect follow-up; did not expose patients to any risk of physical, psychological or other harm; and used no biological samples. The study adhered to the tenets of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Standard layout of ETDRS grid. (a). Display of 9 macular subfile areas based on ETDRS. (b). 9 areas of the ETDRS subfield of the right eye. (c). 9 subfields of ETDRS of the left eye[10] Source: 10.1186/s12886-018-0842-y.
Fig. 2
Fig. 2
Microperimetry (in dB) is superimposed over a color fundal photo in the case of DME with hard exudate. Decreased retinal sensitivity is especially noticeable in the central and inferior areas of the macula. (A) The visit prior to the injection of anti-VEGF, UCVA 0.8 LogMAR, showed fluid in the intraretinal layer, accompanied by accumulation of subretinal fluid causing serous foveal detachment. (B) OCT map, CMT in area 1 is 402 μm. (C) RS threshold in MP-3 in corresponding area is 7 dB. (D) 1 month after the injection of the first loading dose of bevacizumab, the resolution of DME appears. (E) CMT in area 1 drops to 242 μm. (F) and RS threshold at exactly the same retinal location as before injection improves to 17 dB. The same is true in areas 2–5 of ETDRS
Fig. 3
Fig. 3
Macular thickness based on examination area (1. central, 2. superior, 3. temporal, 4. inferior, 5. nasal) and time of anti-VEGF injection
Fig. 4
Fig. 4
Retinal sensitivity based on examination area (1. central, 2. arrogant, 3. temporal, 4. inferior, 5. nasal) and antiVEGF injection time
Fig. 5
Fig. 5
Linear regression of central macular thickness on retinal sensitivity
Fig. 6
Fig. 6
Retinal sensitivity before injection, post-injection one week, and post-injection one month
Fig. 7
Fig. 7
Macular thickness pre injection, post one week, post one month
See this image and copyright information in PMC

References

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