Long-term Visual Outcomes and Morphologic Biomarkers of Vision Loss in Eyes with Diabetic Macular Edema treated with Anti-VEGF Therapy.

Abstract

PURPOSE\nTo analyze the morphological characteristics and long-term visual outcomes in eyes with diabetic retinopathy (DR) and diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (VEGF) therapy.\n\n\nDESIGN\nRetrospective clinical cohort study.\n\n\nMETHODS\nSubjects with a long-term follow-up and evidence of resolved DME in at least one visit (study visit) after 5 years of follow-up following the initiation of anti-VEGF therapy were included. At the study visit, structural OCT scans were reviewed for qualitative features reflecting a distress of the neuroretina or retinal pigment epithelium (RPE). A quantitative topographical assessment of the inner and outer retinal thicknesses was also provided.\n\n\nRESULTS\nSixty-one eyes (50 patients) were included and divided into two subgroups according to the visual acuity (VA) at the study visit, yielding a group of 24 eyes with a VA<20/40 ( poor/intermediate vision group), and 37 eyes with a VA≥20/40 ( good vision group). The external limiting membrane (ELM) and RPE bands were more frequently disrupted/absent in the poor/intermediate vision group (P=0.003 and P=0.019). Similarly, disorganization of retinal inner layers (DRIL) was more prevalent in the poor/intermediate vision group (P=0.013). The foveal and parafoveal outer retinal thicknesses were reduced in poor/intermediate vision eyes (P=0.022 and P=0.044). Multivariate stepwise linear regression analysis demonstrated that VA was associated with appearances of the RPE and ELM (P<0.0001 and P=0.048), foveal and parafoveal outer retinal thicknesses (P=0.046 and P=0.035).\n\n\nCONCLUSIONS\nModifications in the outer retina and RPE represent OCT biomarkers of long-term visual outcomes in eyes with DME treated with anti-VEGF.