Biomarkers of Diabetic Macular Edema on Optical Coherence Tomography After Cataract Surgery

Purpose: To evaluate how 6 features of diabetic macular edema (DME), including intraretinal cyst size, ellipsoid zone (EZ) integrity, disorganization of the retinal inner layers (DRIL), hyperreflective foci, subretinal fluid, and foveal contour, evolve on optical coherence tomography (OCT) after cataract surgery with intraoperative and ongoing postoperative treatment with intravitreal (IVT) bevacizumab or triamcinolone. Secondary objectives included correlating these OCT features with best-corrected visual acuity (BCVA). Methods: In the Diabetic Macular Edema at the time of Cataract Surgery trial, patients with cataracts and center-involving DME were randomized at the time of cataract surgery to IVT triamcinolone or bevacizumab. Both treatment groups were included in this post-hoc analysis. Baseline preoperative macular OCT scans were obtained and at 1, 3, and 6 months postoperatively. Imaging features were assessed and graded as per the TCED-HFV protocol. An overall grading score of OCT structural changes was developed to explore the predictability of BCVA. The associations between OCT features of DME and BCVA were assessed with the Wilcoxon rank-sum test. Results: Forty-five eyes (42 patients) were included in the analysis. OCT features remained stable over the follow-up period. BCVA was correlated with increased intraretinal cyst size, the presence of DRIL, EZ disruption or loss, and TCED-HFV score. Baseline TCED-HFV scores predicted visual outcomes and remained stable. Conclusions: Imaging features of DME remained stable with postoperative treatment. Visual outcomes correlated with OCT features and staging, emphasizing the predictive role of preoperative imaging biomarkers.