Treatment Of Diabetic Macular Edema Research Articles

Subthreshold Micropulse Laser for Diabetic Macular Edema: A Review.

Diabetic macular edema (DME) is one of the main causes of visual impairment in patients of working age. DME occurs in 4% of patients at all stages of diabetic retinopathy. Using a subthreshold micropulse laser is an alternative or adjuvant treatment of DME. Micropulse technology demonstrates a high safety profile by selectively targeting the retinal pigment epithelium. There are no standardized protocols for micropulse treatment, however, a 577 nm laser application over the entire macula using a 200 μm retinal spot, 200 ms pulse duration, 400 mW power, and 5% duty cycle is a cost-effective, noninvasive, and safe therapy in mild and moderate macular edemas with retinal thickness below 400 μm. Micropulse lasers, as an addition to the current gold-standard treatment for DME, i.e., anti-vascular endothelial growth factor (anti-VEGF), stabilize the anatomic and functional retinal parameters 3 months after the procedure and reduce the number of required injections per year. This paper discusses the published literature on the safety and application of subthreshold micropulse lasers in DME and compares them with intravitreal anti-VEGF or steroid therapies and conventional grid laser photocoagulation. Only English peer-reviewed articles reporting research within the years 2010-2022 were included.

New Drugs for the Treatment of DME and the Role of Biomarkers in Predicting Their Effectiveness

Today, between 230 and 347 million people on the planet suffer from diabetes, which is approximately 6 % of the all adult population. Diabetic macular edema (DME) can occur at any stage of diabetic retinopathy (DR), and remains the most common cause of moderate vision loss in patients with DR, due to increased retinal vascular permeability leading to accumulation of extracellular/intracellular fluid and blood plasma components in the neurosensory retina. The use of objective, quantifiable medical signs, called biomarkers, has become more relevant in clinical practice and clinical research. They allow the identification of a normal biological or pathological process, becoming clinical and diagnostic tools in routine clinical practice. Over the past decade, there has been significant progress in the treatment of macular edema, but the search for a more effective method does not stop. Modern research is being carried out in the direction of creating new drugs and increasing the intervals between injections. New molecules target previously studied as well as new targets. The pharmaceuticals used are investigating at higher doses and different delivery methods. Viral vectors and new phototherapeutic agents are currently being tested. This wide range of research studies, with several therapeutics currently in phase 3, could lead to impressive results in the treatment of diabetic retinopathy in the not too distant future.

Supplementary statement on IVOM drugs for the treatment of diabetic macular edema with foveal involvement : Statement of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Status 28 October 2022

Supplementary statement on IVOM drugs for the treatment of diabetic macular edema with foveal involvement : Statement of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Status 28 October 2022

Роль блокады ангиогенеза у пациентов с диабетической ретинопатией

Relevance. The proliferative stage of diabetic retinopathy is characterized by angiogenesis, which is largely mediated by the vascular endothelial growth factor. Peripheral retinal laser coagulation has been standard treatment for PDR for many years, providing control of ischemia and reduction of vascular endothelial growth factor levels with subsequent regression of neovascularization. However, it leads to serious functional deficits and anatomical complications. The advent of antivascular endothelial growth factor (anti-VEGF) agents has changed the future of PDR management and has provided an alternative to pan retinal photocoagulation. Their combination with panretinal photocoagulation may be effective for the treatment of proliferative diabetic retinopathy and concurrent diabetic macular edema. Anti-VEGF therapy also takes place in surgery of complicated PDR. Purpose. To analyze the relevance of the use of anti-VEGF drugs in the treatment of the proliferative stage of diabetic retinopathy. Material and methods. The literature review is written using PubMed, Сochrane Library, 29 literature references published up to 2021. Results. In patients with severe cases, preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Conclusion. Preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Key words: anti-VEGF, diabetic macular edema, proliferative diabetic retinopathy.

Clinical efficacy and safety of intravitreal fluocinolone acetonide implant for the treatment of chronic diabetic macular oedema: five-year real-world results.

To report 5-year real-world efficacy and safety data following the treatment of chronic diabetic macular oedema (DMO) with the intravitreal 0.19 mg fluocinolone acetonide implant(ILUVIEN). Retrospective cohort study of 31 eyes treated with ILUVIEN for chronic DMO at a tertiary centre in Birmingham (UK). Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at baseline, and then at 1-,2-,3-, and 5-years. Safety was assessed based on intraocular pressure (IOP) -lowering medication, surgery, and other complications. BCVA significantly improved 1-year post-ILUVIEN (+4.2 letters, p < 0.05) and gradually reverted to baseline levels over the 5-year period of follow-up (+0.2 letters at year-5). A significant and sustained CRT reduction was observed throughout the 5-years. The proportion of eyes on IOP-lowering medication increased from 16% at baseline, to 70% at 5-years (p < 0.001) with eyes on a mean of 1.3 medications. Laser trabeculoplasty (n = 2), cyclodiode laser (n = 1), and trabeculoplasty and trabeculotomy (n = 1, in the same eye; 3.2%) were required for uncontrolled IOP. Other complications included endophthalmitis (n = 1) and vitreous haemorrhage (n = 1). 58% of eyes required additional intravitreal injections, with a mean 29.2 months to first injection. We observed a 69% reduction in treatment burden following treatment with ILUVIEN implant. Our real-world results confirm the efficacy of the ILUVIEN implant over 5 years, with two-thirds of eyes having improved or stable visual acuity 5 years after ILUVIEN, and an overall sustained improvement in anatomical outcome. Although the rate of IOP-lowering medications use was higher than previously reported, the rate of incisional IOP-lowering surgery and other complications remained low and in keeping with rates reported in larger studies.

Albuminuria as a biomarker of severity in diabetic retinopathy and in the response to intravitreal treatment in diabetic macular edema.

Diabetic macular edema (DME) presents a suboptimal response to antiangiogenic treatment in approximately 30% of patients. We analyzed the relationship between renal function and response to antiangiogenic therapy in patients with DME. A total of 367 patients were collected and distributed into three main groups: uncomplicated diabetic retinopathy (DR) group (n = 97), proliferative diabetic retinopathy (PDR) group (n = 94) and DME group (n = 175). Likewise, patients with DME were divided into two groups: responders to antiangiogenic drugs (n = 96) and non-responders to antiangiogenic drugs (n = 79). Age, type of diabetes, arterial hypertension (AHT), creatinine, HbA1c, albuminuria and glomerular filtration rate were analyzed. In the statistical analysis, chi-square test and t student were used to compare each group. The relationship between albuminuria and response to treatment in the DME group was studied with a binary logistic regression model, estimating odds ratio and their confidence intervals. There are differences between the three main groups in terms of the presence or not of albuminuria. The presence of albuminuria is greater in the group of patients with more severe DR (PDR and DME), compared to the uncomplicated DR group (p < 0.009). In the logistic regression analysis model, a positive relationship was found and the odds ratio for the albuminuria variable and is 2.78 (CI: 1.42-5.36). The presence of albuminuria is associated with a higher degree of DR and worse response to antiangiogenic therapy in patients with DME in our series. Multidisciplinary teams would be necessary to reduce albuminuria and thus optimize the treatment of patients with DME.

Subfoveal choroidal thickness following pars plana vitrectomy in tractional diabetic macular edema.

To evaluate changes in subfoveal choroidal thickness (SCT) in cases of tractional diabetic macular edema (DME) after pars plana vitrectomy (PPV). This prospective study included 31 eyes of 31 patients who underwent PPV for the management of tractional DME. Best-corrected visual acuity (BCVA), SCT, and central macular thickness (CMT) were measured before the operation, as well as one, three, and six months following the surgery in the operated eyes and at baseline, as well as six months in the fellow eyes. The SCT decline in eyes with tractional DME was statistically significant six months postoperatively (P = 0.009). A statistically significant decline was observed in the CMT values one, three, and six months postoperatively in eyes with tractional DME (P = 0.02, P < 0.001, and P < 0.001, respectively). There was a statistically significant improvement in the visual acuity of the affected eyes three (P = 0.047) and six months (P = 0.017) postoperatively. After PPV for the treatment of tractional DME, a statistically significant decrease in the CMT values is detectable from the first month after surgery, followed by the improvement of BCVA from the third month. It is worth mentioning that a decrease was found in the SCT six months postoperatively.

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling.

The effectiveness of internal limiting membrane (ILM) peeling in the surgical treatment of tractional diabetic macular edema (DME), although widely examined, remains controversial. This study aimed to assess the efficacy of pars plana vitrectomy (PPV) in the management of tractional DME and to highlight any benefits of additional ILM peeling. This was an open-label, prospective, comparative, and interventional study that enrolled 50 eyes with tractional DME that underwent PPV and allocated each to one of two groups: group A consisted of 25 eyes that had no ILM peeling and group B consisted of 25 eyes that underwent ILM peeling. Postoperative assessments of best-corrected distance visual acuity (BCDVA) in the logarithm of minimal angle of resolution (logMAR) notation and central macular thickness (CMT) were performed at 1, 3, and 6 months postoperatively. At baseline, the two groups were comparable in terms of sex ratios, phakic status, insulin use, coexistence of hypertension, and mean (standard deviation [SD]) age, BCDVA, CMT, duration of diabetes mellitus, and glycosylated hemoglobin (HbA1c) levels. In group A, the mean (SD) BCDVA improved significantly from 0.89 (0.12) logMAR preoperatively to 0.64 (0.24) logMAR (P < 0.001), and the mean (SD) CMT declined significantly from 471.28 (80.83) µm to 228.20 (26.45) µm (P < 0.001), at the 6-month postoperative assessment. Likewise, in group B, the mean (SD) BCDVA improved significantly from 0.83 (0.10) logMAR preoperatively to 0.58 (0.24) logMAR (P < 0.001), and the mean (SD) CMT decreased significantly from 496.84 (89.82) µm to 226.20 (18.04) µm (P < 0.001), after 6 months. There were no significant differences between groups A and B in the changes in BCDVA (Delta BCDVA) or CMT (Delta CMT) at 1, 3, and 6 months postoperatively with respect to the baseline values (all P > 0.05). Postoperative complications were comparable between the two groups. A significant negative correlation was detected between the preoperative HbA1c level and BCDVA improvement in all participants (r = - 0.82; P < 0.001). PPV is an effective treatment for tractional DME. Additional ILM peeling was not significantly associated with functional and anatomical benefits over a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in patients with diabetes. Further long-term studies are required to verify our findings.

Dexamethasone intravitreal implant in the treatment of diabetic macular edema

Dexamethasone intravitreal implant in the treatment of diabetic macular edema

EE405 A UK Cost-Minimisation Analysis of Brolucizumab Versus Aflibercept in Diabetic Macular Oedema (DMO)

Brolucizumab 6mg is a recently approved treatment for diabetic macular oedema (DMO). It exhibited non-inferior vision gains to aflibercept 2mg with >50% of patients maintained on 12 weekly (q12w) dosing intervals through week 52 (KESTREL and KITE pivotal studies). This analysis evaluated the lifetime costs of patients treated with brolucizumab versus those treated with aflibercept from the UK National Health Service (NHS) perspective.

EE430 Cost-Effectiveness of Faricimab in Patients With Diabetic Macular Edema in Canada

Faricimab is a bispecific antibody targeting ANG-2 and VEGF for the treatment of diabetic macular edema (DME). In the YOSEMITE and RHINE trials, patients treated with faricimab in a Treat & Extend (T&E) regime required less frequent treatments compared to Aflibercept given every eight weeks (Q8W) with non-inferior vision changes. However, clinical practice in DME in Canada is typically characterized by pro re nata (PRN) regimens as well as T&E. This research aims to assess the cost-effectiveness of faricimab vs. anti-VEGF treatments applied in such regimens.

Diabetic macular edema

AbstractThe main diabetic macular edema (DME) treatment options include intravitreal injections of anti‐VEGF agents and intravitreal injections of corticosteroids. In the past, macular laser photocoagulation (LP) was a standard of DME treatment, however, now it is utilized as an additional treatment. Two most important techniques of LP in patients with DME include focal photocoagulation and the grid laser. According to European Society of Retina Specialists (EURETINA) guidelines focal or grid laser should be utilized mainly for non‐center involving DME. In recent years anti‐VEGFs were found superior over typical laser treatment in DME patients. However, new tissue‐sparing technique, subthreshold micropulse laser (SML), avoids protein coagulation and prevents retinal scars, allowing retinal anatomic and functional preservation. It helps to improve or stabilize visual function and decrease macular thickness in treatment of DME.Corticosteroids are often used as an alternative therapy for eyes with insufficient response to anti‐VEGF treatment because they act on different targets than anti‐VEGF agents leading to by inflammation reduction, decrease in the disruption of the blood‐retinal barrier, and retinal angiogenesis. The major steroids used in the treatment of DME include triamcinolone acetonide (TA), dexamethasone (DEX) and fluocinolone acetonide (FA). It is known, however, that steroids frequently increase the intraocular pressure, and are related with the risk of cataract development.

Effect of intravitreal dexamethasone implant in treatment-naive and previously-treated patients with diabetic macular edema.

To document the effects of intravitreal dexamethasone implant on retinal microvasculature in patients with diabetic retinopathy complicated by center-involving macular edema. 35 eyes of 35 patients affected by retinopathy due to type 2 diabetes (15 treatment-naïve and 20 previously treated) were included in this retrospective study with a follow-up of 4 months. Foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) and deep capillary plexus (DCP) densities in the foveal and parafoveal areas were measured by optical coherence tomography angiography (OCTA) at baseline and 2 and 4 months post-injection. Intraocular pressure, morphological and functional parameters were evaluated. a significant difference was found in both groups at 2 months after injection in terms of functional (BCVA, p < 0.05) and morphological (CMT, p < 0.05) parameters. During follow-up, FAZ area, SCP, and DCP in the foveal and parafoveal areas did not change significantly. intravitreal dexamethasone implant is effective in the treatment of diabetic center-involving macular edema and was associated with significant improvements in BCVA and CMT at 2 months after injection. After a single dexamethasone implant injection, FAZ area and retinal vascular density does not show significant variations in both naive and non-naive DME patients subgroups.

Cost-effectiveness of dexamethasone compared with aflibercept in naïve diabetic macular edema

BackgroundTo assess the cost-effectiveness of the delayed-release device of dexamethasone compared with aflibercept in the treatment of patients with naïve diabetic macular edema (DME) from a societal perspective in the healthcare sector Zaragoza III in Spain.MethodsA Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale) and an additional death state were constructed. Two cohorts of patients were distributed along the VA states and treated during a year with either dexamethasone or aflibercept. One-year follow-up on each group was performed. Medical costs related to the DME treatment and follow-up, medical costs related to the DME comorbidities, and non-medical-related costs were taken into account. Costs (2020 €), health outcomes (Quality-Adjusted Life Years-QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY) were determined for a lifetime horizon in the base case analysis.ResultsPatients treated with dexamethasone were €77,349 more costly and provided 2.667 additional QALYs (€29,002/QALY) than those treated with aflibercept. The variable efficiency per patient was calculated dividing the improvement in quality of life (on the VFQ-25 scale) by the cost of the treatment. With the obtained results it can be concluded that the efficiency of treating the patients with dexamethasone is significantly superior than the efficiency of treating them with aflibercept.ConclusionsThe cost per QALY gained with the delayed-release device of dexamethasone compared with the one obtained by aflibercept in the naïve DME population is just below the €30,000 threshold, below which, new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon, the chosen extrapolation method and the number of aflibercept and dexamethasone injections.

To Determine the Efficacy of Suprachoroidal Triamcinolone Injection for the Treatment of Refractory Diabetic Macular Edema

Goal: To determine the safety and effectiveness of suprachoroidal triamcinolone injections (SCT) in refractory diabetic macular edema cases. Study Design: An Interventional case series. Place and Duration: In the Ophthalmology department of Allama Iqbal Memorial Teaching Hospital, Sialkot for six-months duration from January 2021 to June 2021 Methods: A total of 40 eyes from patients with type-I or II diabetes who were over the age of 18 years and were included. Inclusion criteria for the study included patients with treatment resistant central Diabetic Macular Edema of at least 320 um or above (as determined by Zeiss Cirrus HD-OCT) and a BCVA of equal to or less than 20/40. The central subfield thickness (CST), BCVA, and intraocular pressure (IOP) were all documented. Patients who had received suprachoroidal triamcinolone (SCTA) were monitored for 3-months and the similar clinical parameters were noted, and the findings were noted. Results: The results showed that 22 (55%) of the 40 patients were female and 18 (45%) were male. The 0.9± 0.22 was the mean log MAR BCVA and 612.89± 195.58 um was the mean pre-injection CST. In the first and third months, the mean post-injection CST was 308.59± 56.75um and 304.89± 54.29um, respectively. After injection at 1 and 3-months, the mean log MAR BCVA was 00.51± 0.3 and 0.36 ±0.20, correspondingly. At the first and third months, the results for pre- and post-injection CST were statistically significant (p value &lt;0.00001). Conclusion: The reduction of refractory diabetic macular edema and improvement of macular thickness on OCT can both be accomplished safely and effectively using CST. Keywords: Central subfield thickness, suprachoroidal triamcinolone, diabetic macular edema.

Preliminary Study of Different Treatment Responses between Bevacizumab, Aflibercept and Dexamethasone Implant According to Renal Function in Diabetic Macular Edema Patients.

Background: The purpose of this study was to investigate the association between responses to intravitreal bevacizumab injection and renal function in diabetic macular edema (DME) patients. Methods: A retrospective study of the medical records of 104 treatment-naïve DME patients who received intravitreal bevacizumab injection (IVBI) was conducted. Based on the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2), the participants were classified into three groups. Intergroup comparisons of the best-corrected visual acuity (BCVA) and central subfield retinal thickness (CST) changes were performed after three-monthly consecutive IVBIs. In the groups with decreased renal function, the response to further treatment with a different drug was investigated. Results: A total of 104 participants were included in the study: 60 participants in the preserved renal function group (eGFR ≥ 60), 25 participants in the moderate chronic kidney disease (CKD) group (30 ≤ eGFR < 60), and 19 participants in the severe CKD group (eGFR < 30). After three-monthly consecutive IVBIs, BCVA (p < 0.001) and CST (p < 0.001) were significantly improved only in the preserved renal function group. Following further treatment of patients with decreased renal function, the treatment results were significantly better in those who were switched to aflibercept or dexamethasone implant than in those who were maintained on IVBI. Conclusions: From this preliminary study, we observed that renal function might affect the response to IVBI treatment in patients with DME. In the case of a poor response to initial IVBI treatment for DME in patients with moderate to severe CKD, our study supports switching to the aflibercept or dexamethasone implant.

Aflibercept Monotherapy versus Bevacizumab-First for Diabetic Macular Edema: A Cost Analysis Based on Diabetic Retinopathy Clinical Research Network Protocol AC Results

To calculate the costs of treatment for diabetic macular edema with bevacizumab-first (step therapy) compared with aflibercept monotherapy. Cost analysis of the treatment arms based on a published study. None. Published results from the Diabetic Retinopathy Clinical Research Network protocol AC were used to assess costs. Data incorporated in the usage and outcome model included the frequency of injections, medication type, visits, and imaging. Costs were modeled based on the 2022 Medicare reimbursement data for both facility (hospital-based) and nonfacility settings in Miami. Outcomes were similar in protocol AC so were not differentially studied. Results were extrapolated so as to estimate lifetime (17 years for the age of the cohort). Cost of treatment options. Over the 2 years reported in the protocol AC, the cost required to treat in the facility (nonfacility setting) was $42 000 ($32 000) in the aflibercept monotherapy group and $29 000 ($22 000) in the bevacizumab-first group. Extrapolated modeled lifetime costs were $158 000 ($136 000) and $125 000 ($103 000), respectively. The total cost with bevacizumab-first was 33% lower at year 2 and 21% lower at year 17 compared with aflibercept monotherapy. Savings per year for the 2 years results were $6500 ($5000) in the facility (nonfacility) setting. For the extrapolated 17 years model, annual savings were $1900 ($1900) in the facility (nonfacility) setting. The professional fees accounted for a minority of overall costs; in contrast, medication costs accounted for 82% of the total costs for the aflibercept monotherapy and 73% in the bevacizumab-first group at 2 years. Our model predicted an additional 15% lifetime cumulative savings if patients still not meeting the threshold criteria after switching to aflibercept were placed back on bevacizumab, and a similar degree of improvement if those on not meeting threshold criteria on aflibercept monotherapy were switched to bevacizumab. Medication is the dominant driver of the total expenses associated with the treatment of diabetic macular edema. Although cost savings are realized with bevacizumab-first step therapy, the magnitude was not as much as might be intuited, probably because of the high (70%) incidence of patients switching to aflibercept within protocol AC.

Relationship Between Macular Thickness and Visual Acuity in the Treatment of Diabetic Macular Edema With Anti-VEGF Therapy: Systematic Review.

To examine the relationship between central macular thickness (CMT) measured by optical coherence tomography (OCT) and visual acuity (VA) in patients with center-involving diabetic macular edema (DME) receiving antivascular endothelial growth factor (anti-VEGF) treatment. Peer-reviewed articles from 2016 to 2020 reporting intravitreal injections of bevacizumab, ranibizumab, or aflibercept that provided data on pretreatment (baseline) and final retinal thickness (CMT) and visual acuity (VA) were identified. The relationship between relative changes was assessed via a linear random-effects regression model controlling for treatment group. No significant association between the logarithm of the minimum angle of resolution (logMAR) VA and CMT was found in 41 eligible studies evaluating 2667 eyes. The observed effect estimate was a 0.12 increase (95% CI, -0.124 to 2.47) in logMAR VA per 100 µm reduction in CMT after treatment change. There were no significant differences in logMAR VA between the anti-VEGF treatment groups. There was no statistically significant relationship between the change in logMAR VA and change in CMT as well as no significant effect of the type of anti-VEGF treatment on the change in logMAR VA. Although OCT analysis, including measurements of CMT, will continue to be an integral part of the management of DME, further exploration is needed on additional anatomic factors that might contribute to visual outcomes.

Selective Activation of the Wnt-Signaling Pathway as a Novel Therapy for the Treatment of Diabetic Retinopathy and Other Retinal Vascular Diseases.

Retinal ischemia, often associated with various disorders such as diabetic retinopathy (DR), retinal vein occlusion, glaucoma, optic neuropathies, stroke, and other retinopathies, is a major cause of visual impairment and blindness worldwide. As proper blood supply to the retina is critical to maintain its high metabolic demand, any impediment to blood flow can lead to a decrease in oxygen supply, resulting in retinal ischemia. In the pathogenesis of DR, including diabetic macular edema (DME), elevated blood glucose leads to blood-retina barrier (BRB) disruptions, vascular leakage, and capillary occlusion and dropouts, causing insufficient delivery of oxygen to the retina, and ultimately resulting in visual impairment. Other potential causes of DR include neuronal dysfunction in the absence of vascular defect, genetic, and environmental factors. The exact disease progression remains unclear and varies from patient to patient. Vascular leakage leading to edema clearly links to visual impairment and remains an important target for therapy. Despite recent advances in the treatment of DME and DR with anti-VEGFs, effective therapies with new mechanisms of action to address current treatment limitations regarding vessel regeneration and reperfusion of ischemic retinal areas are still needed. The Wnt signaling pathway plays a critical role in proper vascular development and maintenance in the retina, and thus provides a novel therapeutic approach for the treatment of diabetic and other retinopathies. In this review, we summarize the potential of this pathway to address treatment gaps with current therapies, its promise as a novel and potentially disease modifying therapy for patients with DR and opportunities in other retinal vascular diseases.

Qualitative OCT biomarkers for visual improvement in treatment of diabetic macular edema

To identify baseline qualitatative OCT biomarkers that can predict good visual outcome in diabetic macular edema after treatment. Prospective, observational study in the time period. We included 37 eyes of 37 patients with treatment naïve diabetic macular edema who subsequently underwent treatment with injections of intravitreal Ranibizumab. Inclusion criteria was: Presenting vision &amp;#60; 0.3 logMaR (2) centre involving diabetic macular edema (CMT&amp;#62;250 microns). 3 injections were given monthly irrespective of treatment response followed by PRN dosing. Factors under evaluation were: 1) Submacular detachment (SMD) (2) cystoid changes in the inner and outer nuclear layer (4) Integrity of IS-OS junction. (5) Hyper Reflective Foci(HRF) and location (6) vitreomacular interface (7) Disruption of inner retinal layers(DRIL) We included 37 eyes in our study. For analysis, based on final visual acuity patients were divided in two groups: (1) Group A: Good visual acuity (&amp;#62;10 ETDRS letter gain) and (2) Group B: Poor visual outcome (&amp;#60; 10 letter gain). Presence of SMD was more likely in Group B as compared to Group A. There was no significant difference between two groups for other mentioned parameters. Presence of SMD was found to have most significance in predicting good visual acuity response to anti VEGF.DRIL was found to decrease during the treatment but a predictive role could not be demonstrated.