Janejit Choovuthayakorn1, Apichat Tantraworasin2,3, Phichayut Phinyo4,5,6, Jayanton Patumanond3, Paradee Kunavisarut1, Titipol Srisomboon1, Pawara Winaikosol1, Direk Patikulsila1, Voraporn Chaikitmongkol1, Nawat Watanachai1, Kessara Pathanapitoon1. 1. Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 2. Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 3. Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 4. Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. phichayutphinyo@gmail.com. 5. Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. phichayutphinyo@gmail.com. 6. Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand. phichayutphinyo@gmail.com.
Abstract
BACKGROUND: To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in eyes with visual impairment from center-involved diabetic macular edema (CI-DME). METHODS: Medical records of patients with visual impairment from CI-DME, who initiated intravitreal bevacizumab injections between Jan 2012 and Dec 2016 and were followed for a minimum of 12 months were retrospectively reviewed. RESULTS: The study included 226 eyes with a mean (SD) baseline visual acuity (VA) of 51.8 (19.1) letters. At week 12, following the three initial treatments, a mean (SD) VA improved to 61.7 (17.8) letters. Visual gain ≥ 10 letters was observed in 109 eyes (48.2%), while a limited early visual gain < 5 letters was noted in 80 eyes (35.4%). At one year, 110 eyes (48.7%) achieved a good VA gain ≥ 10 letters. In addition, eyes with poor baseline VA had a higher proportion of eyes that obtained limited early VA gained at week 12 (< 5 letters) and maintained in this visual response category at moth 12 compared to eyes with better baseline VA (74.1% versus 59.1%). In the multivariable logistic regression, the following factors reduced the probability of 1-year visual gain ≥ 10 letters: elderly (p = 0.040), better baseline vision (p = 0.001), and limited early visual gain < 5 letters at week 12 (p < 0.001). In multivariable linear regression, male (p = 0.010) and eyes with the presence of hyperreflective foci on baseline OCT (p = 0.010) were likely to have higher VA improvement. However, eyes with better baseline VA (p = 0.002), limited early VA gain at week 12 (p < 0.001), and a presence of EZ disruption at week 12 (p = 0.002) were likely to have less VA improvement. CONCLUSIONS: Although bevacizumab is considered as effective management for CI-DME, variability in treatment responses is expected. This study revealed that baseline characteristics and visual responses at week 12 might help predict the long-term treatment response. Eyes with characteristics at risk of limited long-term visual outcome may require attention in optimizing their individual treatment strategies.
BACKGROUND: To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in eyes with visual impairment from center-involved diabetic macular edema (CI-DME). METHODS: Medical records of patients with visual impairment from CI-DME, who initiated intravitreal bevacizumab injections between Jan 2012 and Dec 2016 and were followed for a minimum of 12 months were retrospectively reviewed. RESULTS: The study included 226 eyes with a mean (SD) baseline visual acuity (VA) of 51.8 (19.1) letters. At week 12, following the three initial treatments, a mean (SD) VA improved to 61.7 (17.8) letters. Visual gain ≥ 10 letters was observed in 109 eyes (48.2%), while a limited early visual gain < 5 letters was noted in 80 eyes (35.4%). At one year, 110 eyes (48.7%) achieved a good VA gain ≥ 10 letters. In addition, eyes with poor baseline VA had a higher proportion of eyes that obtained limited early VA gained at week 12 (< 5 letters) and maintained in this visual response category at moth 12 compared to eyes with better baseline VA (74.1% versus 59.1%). In the multivariable logistic regression, the following factors reduced the probability of 1-year visual gain ≥ 10 letters: elderly (p = 0.040), better baseline vision (p = 0.001), and limited early visual gain < 5 letters at week 12 (p < 0.001). In multivariable linear regression, male (p = 0.010) and eyes with the presence of hyperreflective foci on baseline OCT (p = 0.010) were likely to have higher VA improvement. However, eyes with better baseline VA (p = 0.002), limited early VA gain at week 12 (p < 0.001), and a presence of EZ disruption at week 12 (p = 0.002) were likely to have less VA improvement. CONCLUSIONS: Although bevacizumab is considered as effective management for CI-DME, variability in treatment responses is expected. This study revealed that baseline characteristics and visual responses at week 12 might help predict the long-term treatment response. Eyes with characteristics at risk of limited long-term visual outcome may require attention in optimizing their individual treatment strategies.
Authors: J Fernando Arevalo; Andres F Lasave; Lihteh Wu; Manuel Diaz-Llopis; Roberto Gallego-Pinazo; Arturo A Alezzandrini; Maria H Berrocal Journal: Retina Date: 2013-02 Impact factor: 4.256
Authors: Neil M Bressler; Wesley T Beaulieu; Maureen G Maguire; Adam R Glassman; Kevin J Blinder; Susan B Bressler; Victor H Gonzalez; Lee M Jampol; Michele Melia; Jennifer K Sun; John A Wells Journal: Am J Ophthalmol Date: 2018-08-02 Impact factor: 5.258
Authors: Gabriele E Lang; András Berta; Bora M Eldem; Christian Simader; Dianne Sharp; Frank G Holz; Florian Sutter; Ortrud Gerstner; Paul Mitchell Journal: Ophthalmology Date: 2013-05-29 Impact factor: 12.079