Abstract
BackgroundsTo assess the changes in individual retinal layer thickness and visual function associated with gains in visual acuity after an intravitreal conbercept injection in the diabetic macular edema (DME) on spectral domain optical coherence tomography (SD-OCT) and microperimetry during 1-year follow-up.MethodsRetrospective observational study. Twenty patients with clinically significant DME in the study eye were imaged by SD-OCT every 3 months and MP1 microperimeter in the third month while receiving anti-vascular endothelial growth factor (VEGF) (conbercept) treatment. In each patient, seven retinal layers were segmented in 98 scans covering a 6 mm × 6 mm area of the macula at baseline and during 1 year of treatment. An automatic, full-threshold microperimetry of the central field (10° × 10°, 40 stimulated points) with the MP1 microperimeter. Thickness and microperimetry changes were quantitatively measured and evaluated for their correlation with increases in visual acuity.ResultsAlthough thicknesses of the inner nuclear layer (INL) and the outer nuclear layer (ONL) were reduced the most after treatment (p < 0.05), decreases of the ganglion cell layer (GCL) (r = 0.591, p = 0.006) and inner plexiform layer (IPL) (r = 0.663, p = 0.001) in central subfield area was associated with best-corrected visual acuity (BCVA) gain, and had the best estimation of BCVA gain (adjust R2 = 0.544). Mean macular sensitivity in the central subfield was also well correlated with BCVA gain (r = 0.531, p = 0.016).ConclusionsNeural recovery occurred after the resolution of edema during conbercept treatment, due to the decreases in GCL and IPL associating with gains in vision and improved microperimetry.
Highlights
Diabetic retinopathy (DR) is one of the leading causes of vision loss among working-aged adults globally [1]
A recent study compared the changes in layer thickness of diabetic macular edema (DME) patient after 1-year of anti-vascular endothelial growth factor (VEGF) or cortisone and found that the decrease in retinal nerve fiber layer (RNFL) may have a possible impact on best-corrected visual acuity (BCVA) gain [12]
All patients were treated with conbercept monotherapy
Summary
Diabetic retinopathy (DR) is one of the leading causes of vision loss among working-aged adults globally [1]. Of the estimated 382 million people with diabetes mellitus worldwide [2], approximately 35% have signs of DR; of these, a further one third of DR cases are vision-threatening DR, most of which are diabetic macular edema (DME) [3]. Prolonged hyperglycemia in DME patients causes hypoxia and inflammation, resulting in an upregulation of growth. Total retinal thickness has often been used to monitor treatment effectiveness of anti-VEGF therapy for DME [8, 9]. Changes in the individual retinal layer might serve as a biomarker for response to treatment [10, 11]. A recent study compared the changes in layer thickness of DME patient after 1-year of anti-VEGF or cortisone and found that the decrease in retinal nerve fiber layer (RNFL) may have a possible impact on best-corrected visual acuity (BCVA) gain [12]
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