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Longitudinal Quantitative Ultrawide-field Fluorescein Angiography Dynamics in the RUBY Diabetic Macular Edema Study
Kubra Sarici1, Sari Yordi1, Alison Martin1
1The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Ophthalmology. Retina
|February 3, 2023
Summary
Ultrawide-field angiography (UWFA) revealed significant improvements in leakage and microaneurysm burden in diabetic macular edema (DME) patients treated with aflibercept. These UWFA changes correlated with better visual acuity and reduced retinal fluid, suggesting UWFA
Area of Science:
- Ophthalmology
- Medical Imaging
- Diabetic Retinopathy Research
Background:
- Diabetic macular edema (DME) is a leading cause of vision loss.
- Quantitative assessment of retinal changes in DME is crucial for treatment evaluation.
- Ultrawide-field angiography (UWFA) offers a comprehensive view of retinal vasculature.
Purpose of the Study:
- To evaluate longitudinal changes in quantitative UWFA parameters in DME patients.
- To correlate these UWFA changes with functional outcomes (visual acuity) and spectral-domain OCT metrics.
- To assess the utility of UWFA in monitoring DME disease burden.
Main Methods:
- Post hoc analysis of the phase II RUBY study involving patients with DME treated with intravitreal aflibercept injection (IAI) +/- nesvacumab.
- Machine learning-enabled extraction of panretinal quantitative UWFA metrics (leakage, ischemia, microaneurysm burden) and zonal assessments.
- Analysis of spectral-domain OCT metrics (central subfield thickness, ellipsoid zone integrity, fluid volumes) and best-corrected visual acuity (BCVA).
Main Results:
- Significant improvements observed in panretinal leakage index, leakage area, and microaneurysm count from baseline to 36 weeks.
- A decrease in panretinal ischemic index and area was noted, with some aspects showing significant improvement.
- Mean BCVA significantly improved; macular leakage area inversely correlated with BCVA change, and leakage parameters directly correlated with OCT-measured fluid and ellipsoid zone disruption.
Conclusions:
- Quantitative UWFA parameters, particularly leakage, significantly improved in DME eyes treated with IAI +/- nesvacumab.
- UWFA demonstrates a strong association with visual and OCT outcomes, highlighting its potential role in disease burden assessment.
- Leakage parameters derived from UWFA show promise as a primary endpoint for evaluating DME treatments.
