EC Ophthalmology

Research Article Volume 14 Issue 7 - 2023

Association Between Biomarkers in Optical Coherence Tomography and Visual Acuity in Patients with Edema Diabetic Macular Treated with Antiangiogenics

Camila Iris Dorrego1*, Silvana Pellice1, Ana Lisa Carauni1, Luciana Chiapella2, Gimena Dapena1, Pablo Chamartin1, Franco Daniel Rocco1 and Arturo Alberto Alezzandrini3

1Sanatorio Otamendi y Miroli, Universidad de Buenos Aires, Buenos Aires, Argentina
2Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario - CONICET, Argentina
3Oftalmos Centro Oftalmológico de Alta Complejidad, Universidad de Buenos Aires, Buenos Aires, Argentina

*Corresponding Author: Camila Iris Dorrego, Sanatorio Otamendi y Miroli, Universidad de Buenos Aires, Buenos Aires, Argentina.
Received: February 16, 2022; Published: June 29, 2023



Purpose: To evaluate the association between the main bio- markers of Diabetic Macular Edema (DME) and the Visual Acuity (VA), and determine its importance as a prognostic tool at time to start an antiangiogenic treatment in each patient.

Methods: Retrospective, observational and longitudinal cohort study. 25 OCT scans of 23 patients with diabetic macular edema (DME) were analyzed, and the Best Corrected Visual Acuity (BCVA) at baseline and at 3, 6 and 9 months of treatment was registered. Baseline images were evaluated for predominant type of macular edema (cystoid, spongiform, with subfoveal serous detachment, or tractional compromise); presence of outer retinal damage (ORD, considered as any discontinuity in Limiting Extern Membrane, Ellipsoid Zone, and/or Interdigitation Zone); presence of disorganization of the Inner Retinal Layers (DRIL), and Hyperreflective Focus (HF) quantity, as well as Central Macular Thickness (CMT). Correlations between each OCT biomarker and visual acuity gain were analyzed using longitudinal mixed-effects models.

Results: Twenty five eyes with NAIVE DME were included. Baseline best-corrected visual acuity (BCVA) was between 0.3 and 1.3 on a logarithm of minimum angle of resolution visual chart (logMAR). Type of macular edema, DRIL presence, and CMT presented a statistically significant effect on the VA modification along the time (p < 0,001 in all cases). Patients with DRIL showed worse VA in logMAR terms at 9 months than patients without DRIL, being the difference statistically different (p = 0,026), and showed less improvement in VA along the nine months treatment (interaction effect p = 0,007). Eyes with subfoveal serous detachment and eyes with tractional component gained less vision than patients with only cystoid macular edema. There were no statistically significant differences between presence of hyperreflective focus, extern retinal layers alteration and VA along the treatment time.

Conclusion: This study showed that it is useful to assess the initial CMT but not in isolation, and above all the presence of DRIL, which proved to be the tomographic biomarker with the greatest potential as a predictor of clinical response in terms of VA.

Keywords: Diabetic Macular Edema; OCT; Biomarkers; DRIL

  1. Mountain K., et al. “Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)”. Ophthalmologica 4 (2017): 185-222.
  2. Sun JK., et al. “Neural Retinal Disorganization as a Robust Marker of Visual Acuity in Cur- rent and Resolved Diabetic Macular Edema”. Diabetes 7 (2015): 2560-2570.
  3. General THE Kim YH., et al. “Role of Inflammation in Classification of Diabetic Mac- Edema home by Optical Coherence Tomography”. Journal of Diabetes Research (2019): 8164250.
  4. Otani T., et al. “Patterns of diabetic mac- snake edema with optical coherence tomography”. Journal of Ophthalmology6 (1999): 688-693.
  5. Emperor HP., et al. “Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction”. Journal of Ophthalmology 1 (2001): 44-49.
  6. Phadikar P., et al. “The potential of spectral domain optical coherence tomography imaging based retinal biomarkers”. International Journal of Retina and Vitreous 3 (2017): 1.
  7. Schreur V., et al. “Retinal Hyperreflective Foci in 1 diabetes mellitus”. Retina 8 (2020): 1565-1573.
  8. Markan A., et al. “Novel imaging biomarkers in diabetic retinopathy and diabetic macular edema”. Therapeutic Advances in Ophthalmology 212 (2020): 2515841420950513.
  9. Fickweiler W., et al. “Predictive value of optical coherence tomographic features in the bevacizumab and ranibizumab in patients with diabetic macular edema (BRDMe) study”. Retina 4 (2018): 812-819.
  10. Radwan SH., et al. “Association of Disorganization of Retinal Inner Layers with Vision After Resolution of Center-In- volved Diabetic Macular Edema”. JAMA Ophthalmology 7 (2015): 820-825.
  11. Das R., et al. “Disorganization of Inner Retina and Outer Retinal Morphology in Diabetic Macular Edema”. JAMA Ophthalmology 2 (2018): 202-208.
  12. Pelosini L., et al. “Optical coherence tomography may be used to predict visual acuity in patients with macular edema”. Investigative Ophthalmology and Visual Science 5 (2011): 2741-2748.
  13. Panozzo G., et al. “Diabetic macular edema: an OCT-based classification”. Seminars in Ophthalmology 1-2 (2004): 13-20.
  14. Yamamoto T., et al. “Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema”. American Journal of Ophthalmology 1 (2003): 14-19.
  15. Vujosevic S., et al. “Hyperreflective intraretinal spots in diabetics without and with nonproliferative diabetic retinopathy: an in vivo study using spectral domain OCT”. Journal of Diabetes Research (2013): 491835.
  16. Giocanti-Aurégan A., et al. “Functional and Anatomical Outcomes in Patients with Serous Retinal Detachment in Diabetic Macular Edema Treated With Ranibizumab”. Investigative Ophthalmology and Visual Science 2 (2017): 797-800.
  17. Reddy RK., et al. “Efficacy of Ranibizumab in Eyes with Diabetic Macular Edema and Macular Nonperfusion in RIDE and RISE”. Ophthalmology 10 (2018): 1568-1574.
  18. Ho J., et al. “Documentation of intraretinal retinal pigment epithelium migration via high-speed ultrahigh-resolution optical coherence tomography”. Ophthalmology4 (2011): 687-693.
  19. Joussen AM., et al. “TNF-alpha mediated apoptosis plays an important role in the development of early diabetic retinopathy and long-term histopathological alterations”. Molecular Vision 15 (2009): 1418-1428.
  20. Framme C., et al. “Behavior of SD-OCT-detected hyperreflective foci in the retina of anti-VEGF-treated patients with diabetic macular edema”. Investigative Ophthalmology and Visual Science 9 (2012): 5814-5818.
  21. Schreur V., et al. “Hyperreflective foci on optical coherence tomography associate with treatment outcome for anti-VEGF in patients with diabetic macular edema”. PLoS One 10 (2018): e0206482.
  22. Spaide RF and Curcio CA. “Anatomical correlates to the bands seen in the outer retina by optical coherence tomography: literature review and model”. Retina 8 (2011): 1609-1619.
  23. Ito S., et al. “Association between external limiting membrane status and visual acuity in diabetic macular oedema”. British Journal of Ophthalmology 2 (2013): 228-232.
  24. Forooghian F., et al. “Relationship be- tween photoreceptor outer segment length and visual acuity in diabetic macular edema”. Retina 1 (2010): 63-70.
  25. Maheshwary AS., et al. “The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema”. American Journal of Ophthalmology 1 (2010): 63-67.e1.
  26. Murakami T., et al. “Association of pathomorphology, photoreceptor status, and retinal thickness with visual acuity in diabetic retinopathy”. American Journal of Ophthalmology 2 (2011): 310-317.
  27. Kim BY., et al. “Optical coherence tomographic patterns of diabetic macular edema”. American Journal of Ophthalmology3 (2006): 405-412.
  28. Browning DJ., et al. “Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema”. Ophthalmology 3 (2007): 525-536.

Camila Iris Dorrego., et al. Association Between Biomarkers in Optical Coherence Tomography and Visual Acuity in Patients with Edema Diabetic Macular Treated with Antiangiogenics. EC Ophthalmology 14.7 (2023): 01-14.