Abstract
Anti-VEGF drugs are as the first-line therapies for diabetic macular edema (DME). In this study, we investigated the association between hyperreflective foci in the outer retinal layers and functional efficacy in DME patients who received intravitreal ranibizumab (IVR) injections. We retrospectively reviewed 77 eyes of 71 patients with DME treated with pro re nata IVR injections for at least 12 months. We evaluated how baseline hyperreflective foci in the outer retinal layers on spectral domain optical coherence tomography images were associated with an improvement in logarithm of the minimum angle of resolution visual acuity (logMAR VA) at 12 months. Forty-three eyes with hyperreflective foci in the outer retinal layers had greater VA improvement than 34 eyes without such foci at 12 months. Multivariate analyses demonstrated that both logMAR VA and hyperreflective foci in the outer retinal layers at baseline were associated with VA improvement. Structural analyses revealed that the central subfield thickness was decreased and that the ellipsoid zone of photoreceptors was improved more significantly in eyes with hyperreflective foci in the outer layers than eyes without such lesions. Baseline hyperreflective foci in the outer retinal layers predict the functional efficacy of IVR injections for DME.
Highlights
Diabetic macular edema (DME) leads to visual impairment in diabetic patients, mediated via the breakdown of blood-retinal barrier (BRB) and concomitant neuroglial dysfunction[1]
We investigated the changes in hyperreflective foci in the outer retinal layers and their association with functional efficacy at 12 months in eyes with center-involved diabetic macular edema (DME) treated with pro re nata (PRN) intravitreal ranibizumab (IVR) injections[27]
Logarithm of the minimum angle of resolution visual acuity (VA) improved from 0.352 ± 0.275 to 0.231 ± 0.264 and Central subfield (CSF) thickness decreased from 475 ± 109 μm to 331 ± 96 μm at 12 months under PRN IVR injections
Summary
Diabetic macular edema (DME) leads to visual impairment in diabetic patients, mediated via the breakdown of blood-retinal barrier (BRB) and concomitant neuroglial dysfunction[1] Both basic and clinical researches have shown that vascular endothelial growth factor (VEGF) is a main regulator in the pathogenesis of DME, and anti-VEGF treatment has great effects on anatomical and functional outcomes in DME2–5. Www.nature.com/scientificreports with serous retinal detachment (SRD), and the foci in the outer retinal layers than the external limiting membrane (ELM) are associated with photoreceptor damage and visual impairment in eyes without SRD19,25. Such foci are associated with poor visual outcomes in eyes that receive vitrectomy for DME26
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