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Impact of retinal fluid in patients with diabetic macular edema treated with anti-VEGF in routine clinical practice

Published:April 05, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.03.003

      Abstract

      Objective

      This study aims to determine the effect of intraretinal (IRF) and subretinal (SRF) fluid on visual outcomes for diabetic macular edema (DME) patients treated with anti–vascular endothelial growth factor (anti-VEGF) in routine clinical practice.

      Design

      Optical coherence tomography scans were analyzed with a deep-learning artificial intelligence software to quantify IRF, SRF, and total retinal fluid (TRF) at baseline and at 3, 6, and 12 months. Predictive variables for best-corrected visual acuity (BCVA) were evaluated with linear mixed-effects regression models.

      Participants

      A total of 220 DME eyes of 220 patients from the Cole Eye Institute at Cleveland Clinic.

      Methods

      Retrospective, nonrandomized cohort study.

      Results

      BCVA improved from baseline to 12 months (63.36 ± 14.72 to 68.49 ± 13.14 Early Treatment Diabetic Retinopathy Study letters, p < 0.001, respectively). Central subfield thickness improved from baseline to 12 months (411.74 ± 129.7 to 335.94 ± 116.91 mm, p < 0.001, respectively). Injection frequency per patient was 8.25 ± 2.5 injections over 12 months. The linear mixed-effects regression model in the foveal region for TRF, IRF, and SRF volume at the fourth quartile showed BCVA losses of –8.29 letters (range, –10.96 to –5.62 letters, p < 0.001), –7.52 letters (range, –10.3 to –4.74 letters, p < .001), and –6.93 letters (range, –10.54 to –3.41 letters, p < .001), respectively.

      Conclusions

      The highest quartile of TRF, IRF, and SRF volumes led to worse visual outcomes after 12 months of anti-VEGF treatment in patients with DME. Further studies designed to investigate the effect of anti-VEGF treatment on retinal fluid morphology could provide greater insight into individualized DME treatment.
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