Microaneurysm Reflectivity as a Prognostic Biomarker for Intravitreal Treatment Response in Diabetic Retinopathy

Area of Science:

• Ophthalmology
• Medical Imaging
• Diabetic Retinopathy

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Spectral-domain optical coherence tomography (SD-OCT) is crucial for diagnosing and monitoring DME.
• Predicting treatment response in DME remains a clinical challenge.

Purpose of the Study:

• To determine if baseline microaneurysm (MA) reflectivity patterns on SD-OCT can predict treatment response in DME patients.
• To investigate the association between MA phenotype and treatment outcomes.

Main Methods:

• A retrospective cohort study analyzed 66 treatment-naive DME patients.
• Microaneurysms were classified by internal reflectivity on SD-OCT into hyperreflective or hyporeflective phenotypes.
• Patients received anti-VEGF therapy or dexamethasone implants for 12 months.

Main Results:

• 59.1% of patients had a hyperreflective MA phenotype, and 40.9% had a hyporeflective phenotype.
• Complete intraretinal fluid resolution occurred in 51.3% of hyperreflective vs. 7.4% of hyporeflective patients (p<0.001).
• MA phenotype was the sole independent predictor of treatment response (OR 13.50, p<0.001).

Conclusions:

• Microaneurysm reflectivity phenotype on SD-OCT is a significant predictor of treatment response in DME.
• The hyperreflective MA phenotype is associated with substantially higher rates of fluid resolution.
• This finding is independent of patient characteristics and treatment modality, offering a potential biomarker for personalized DME management.