Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response.
To investigate the structural integrity of the superficial capillary plexuses (SCPs) and deep capillary plexuses (DCPs) using optical coherence tomography (OCT) angiography (OCTA) in patients with diabetic macular edema (DME) and its association with the response to anti-vascular endothelial growth factor (VEGF) treatment.



Retrospective, case-control study.



We included 51 DME eyes with a poor response to anti-VEGF agents and 32 age-matched DME eyes with a good response to anti-VEGF treatment, along with 20 fellow eyes without DME from the cases and controls.



The medical records, including OCTA and spectral-domain OCT (SD OCT), were reviewed and compared between the groups. En face OCTA images of the SCP and DCP were obtained for each eye. An anti-VEGF responder was defined by a reduction of more than 50 μm in central retinal thickness after 3 consecutive anti-VEGF treatments. A poor responder was defined by a reduction of less than 50 μm or an increase in central retinal thickness after 3 monthly injections.



We measured the vascular density and foveal avascular zone (FAZ) area and counted the number of microaneurysms in each layer. The SD OCT images were compared with OCTA findings.



Compared with non-DME eyes, DME eyes had a lower vascular density (P < 0.001) and larger FAZ area (P < 0.001) in the DCP and more microaneurysms (P < 0.001) in both layers. Although there was no significant difference in the SCP between anti-VEGF responders and poor responders, poor responders tended to show greater damage and more microaneurysms in the DCP (P < 0.001) and a larger FAZ area (P < 0.001). The topographic location of the disrupted synaptic portion of the outer plexiform layer (OPL) in SD OCT exactly corresponded to the nonflow area of the DCP in OCTA.



Compared with DME eyes that responded to anti-VEGF treatment, poor responders show significant damage to the integrity of the DCP, but not the SCP. The degree of OPL disruption in SD OCT corresponds well with the extent of DCP loss in DME eyes. The extent of DCP loss and the corresponding OPL disruption could be useful predictors of responsiveness to anti-VEGF treatment.
Department of Ophthalmology, Yeungnam University, College of Medicine, Daegu, Korea.
Junyeop
J
Lee
Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; Asan Diabetes Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Byung Gil
BG
Moon
Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; Asan Diabetes Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Ah Ran
AR
Cho
Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; Asan Diabetes Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. Electronic address: yhyoon@amc.seoul.kr.
Young Hee
YH
Yoon
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D016022:Case-Control Studies; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005654:Fundus Oculi; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab