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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Article Info
Publication History
Published online: April 05, 2022
Accepted:
March 9,
2022
Received in revised form:
February 28,
2022
Received:
December 8,
2021
Publication stage
In Press Corrected ProofFootnotes
Presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology, May 7, 2021 (virtual meeting).
Identification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
