Abstract
AIM: To report the visual outcome based on various patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with anti -VEGF intravitreal bevacizumab (IVB) injection.
METHODS: Sixty -seven consecutive subjects with centre involving DME underwent intravitreal injection of bevacizumab (1.25 mg/0.05 mL) in this retrospective, comparative, non randomized study. The DME was classified into one of four categories: focal, diffuse, focal cystoid and neurosensory detachment based on OCT. Best corrected visual acuity (BCVA), macular appearance, and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab. Outcome measures were a change in mean BCVA (Snellen converted to logMAR) and central macular thickness (CMT) in each group during the six month follow-up period.
RESULTS: The mean BCVA improved to logMAR 0.23 at final follow-up from a baseline of 0.32 logMAR (P= 0.040) in the focal group, logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR (P=0.838) in the diffuse group, worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR (P=0.276) in the focal cystoid group, and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR (P=0.490) in the neurosensory detachment group. The mean CMT before treatment were 298.8 +/- 25.03 mu M in the focal group, 310.8 +/- 40.6 mu M in the diffuse group, 397.15 +/- 31.05 mu m in the focal cystoid group and 401.03 +/- 75.1 mu M in the neurosensory detachment group. A mean of 2.05 (range: 1-5) injections in the focal group, 1.32 (range: 1-2) in the diffuse group, 2.6 (range: 1 -6) in the focal cystoid group and 2.6 (range: 1-6) in the neurosensory detachment group were performed during the six month follow -up period. Following intravitreal bevacizumab treatment, vision improved, remained unchanged or worsened in 11, 7 and 2 subjects in focal group; 11, 9 and 8 in diffuse group; 0, 2 and 4 in focal cystoid group and 5, 5 and 3 subjects respectively in neurosensory detachment group.
CONCLUSION: OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment, and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment.