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Decrease in the number of microaneurysms in diabetic macular edema after anti-vascular endothelial growth factor
Kenichiro Mori1, Shigeo Yoshida2, Yoshiyuki Kobayashi1
1Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Purpose:
We evaluated changes in the numbers of microaneurysms (MAs) on fluorescein angiography (FA) and indocyanine green angiography (IA) in eyes with diabetic macular edema (DME) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents.
Methods:
Twenty-one eyes of 16 patients with DME were included in this retrospective study. All patients received an initial loading dose of three monthly injections of anti-VEGF agents; thereafter, they received a pro re nata regimen for at least 12 months of follow-up. FA and IA images were obtained before and at 6 months after the initial injection.
Results:
The median numbers of MAs significantly decreased from six (interquartile range [IQR] 3-7) MAs in early-phase FA, three (IQR 3-5) leaky MAs in late-phase FA, and two (IQR 1-4) MAs in late-phase IA at baseline to two (IQR 1-3) MAs in early-phase FA, one (IQR 0-2) leaky MA in late-phase FA, and one (IQR 0-2) MA in late-phase IA at 6 months (P < 0.0001 for all). Only the median numbers of MAs in late-phase IA at baseline and at 6 months were significantly higher in the recurrent DME group (13 eyes) than in the non-recurrent DME group (five eyes) (three [IQR 2-4] vs one [IQR 1-2], one [IQR 0.5-2] vs zero [P = 0.0185 and P = 0.009]).
Conclusion:
Intravitreal injection of anti-VEGF agents reduced the numbers of MAs in patients with DME. The numbers of MAs detected by late-phase IA might be useful predictors of DME recurrence.
Insights
Anti-vascular endothelial growth factor (VEGF) injections significantly reduced microaneurysms (MAs) in diabetic macular edema (DME) patients. Indocyanine green angiography (IA) may predict DME recurrence.
Area of Science:
- Ophthalmology
- Medical Imaging
- Diabetology
Background:
- Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
- Microaneurysms (MAs) are early indicators of diabetic retinopathy and contribute to DME.
- Anti-vascular endothelial growth factor (VEGF) agents are a primary treatment for DME.
Purpose of the Study:
- To evaluate the impact of intravitreal anti-VEGF agents on the number of microaneurysms (MAs) in eyes with DME.
- To assess changes in MAs using fluorescein angiography (FA) and indocyanine green angiography (IA).
- To explore the potential of IA in predicting DME recurrence.
Main Methods:
- Retrospective analysis of 21 eyes from 16 patients with DME.
- Patients received an initial loading dose of three monthly anti-VEGF injections, followed by a pro re nata regimen.
- FA and IA imaging were performed at baseline and 6 months post-injection.
Main Results:
- Significant reduction in MA counts across early-phase FA, late-phase FA, and late-phase IA (P < 0.0001).
- Median MAs decreased from 6 to 2 (early FA), 3 to 1 (late FA), and 2 to 1 (late IA).
- Higher baseline and 6-month MA counts on late-phase IA were observed in the recurrent DME group (P = 0.0185 and P = 0.009).
Conclusions:
- Intravitreal anti-VEGF therapy effectively reduces MA burden in DME patients.
- Late-phase IA detection of MAs may serve as a predictive biomarker for DME recurrence.
- Further research is warranted to confirm IA's role in DME management and recurrence prediction.
