Foveal Müller Cell Cone as a Prognostic OCT Biomarker for Initial Response to Anti-VEGF Treatment in Cystoid Diabetic Macular Edema.

Abstract

PURPOSE\nTo investigate the effect of the foveal Müller cell cone structure on the anatomical and functional response to intravitreal bevacizumab (IVB) treatment in patients with diabetic macular edema (DME).\n\n\nMETHODS\nIn 93 treatment-naïve eyes with center-involved cystic type DME, spectral-domain OCT scans of baseline were retrospectively evaluated to determine the foveal Müller cell cone structure, and prognostic features including length of disorganization in the retinal inner layers (DRIL) and ellipsoid zone (EZ) disruption. The area and circularity of the foveal avascular zone (FAZ) of the superficial and deep capillary plexus (SCP and DCP) 1 month after IVB were evaluated using OCT angiography.\n\n\nRESULTS\nDestruction of foveal Müller cell cone structure and a large FAZ in the DCP (mm2) correlated strongly with a poor anatomical response (CST > 250 μm) at 1 month after 1st IVB (Exp(B) = 29.444, P = .002 and Exp(B) = 12.419, P = 0.013, respectively). A destroyed Müller cell cone structure (P = 0.008) and length of EZ disruption (P < .001) at baseline were associated with poor visual acuity at 1 month after the 1st IVB.\n\n\nCONCLUSIONS\nThe foveal Müller cell cone structure correlates with the response to initial anti-VEGF treatment.