Efficacy of intravitreal injection of ranibizumab for different patterns of optical coherence tomography of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes_Chinese Journal of Ocular Fundus Diseases

Authors：

Fu Yudong ,  Meng Xuxia , Wang Ping , Liu Penghui , Wang Dabo

Department of Ophthalmology (Fu Yudong, Meng Xuxia, Liu Penghui, Wang Dabo), Department of Endocrinology (Wang Ping), The Affiliated Hospital of Qingdao University, Qingdao 266555, China;

Corresponding author：

Meng Xuxia, Email: mengxuxia@163.com

Keywords：

Diabetic retinopathy/therapy; Macular edema /therapy; Angiogenesis inhibitors/ therapeutic use; Antibodies, monoclonal/ therapeutic use; Tomography, optical coherence

DOI：

10.3760/cma.j.issn.1005-1015.2017.02.005

Video：

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Objective To observe the efficacy of intravitreal injection of ranibizumab (IVR) for different patterns of optical coherence tomography (OCT) of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes. Methods Eighty-five IVR treated eyes were enrolled. The examination of BCVA was according to Early Treatment Diabetic Retinopathy Study, and the results were recorded as logarithm of the minimum angle of resolution (logMAR). Frequency-domain OCT was used to measure the central foveal thickness (CFT) and the integrity of ellipsoidal zone. All eyes were classified as diffuse macular edema (DRT group, 31 eyes), cystoid macular edema (CME group, 29 eyes), and serous retinal detachment (SRD group, 25 eyes). All the patients were treated with intravitreal injection of 0.05 ml (0.5 mg) ranibizumab. The mean follow-up time was (9.21+3.56) months after IVR treatment. The changes of BCVA and CFT in 3 groups were compared and analyzed after 3, 6 and 12 months. According to visual acuity at different ranges, the relationship between integrity of ellipsoidal zone and BCVA was analyzed. Results Compared with the average logMAR BCVA before treatment, except for 12 months after treatment in group SRD (t=2.104,P=0.053), the average logMAR BCVA after IVR at 3 months, 6 months and 12 months improved in DRT group (t=7.847, 6.771, 6.426;P=0.000, 0.000, 0.000), CME group (t=8.560, 6.680, 5.082;P=0.000, 0.000, 0.000) and SRD group (t=5.161, 3.968, 2.104;P=0.000, 0.001, 0.053). The average logMAR BCVA of the DRT group was lesser than that in CME and SRD group after 12 months treatment (t=–2.043, –3.434;P=0.030, 0.001). The average CFT after IVR at 3 months, 6 months and 12 months reduced significantly in DRT group (t=12.746, 10.687, 9.425;P=0.000, 0.000, 0.000), CME group (t=13.400, 11.460, 10.169;P=0.000, 0.000, 0.000), and SRD group (t=11.755, 10.100, 9.173;P=0.000, 0.000, 0.000). After 12 months of treatment, the average CFT of the SRD group was thicker than that in DRT group and CME group (t=–3.251, –1.227;P=0.003, 0.025); there was significant difference in the integrity of ellipsoidal zone among 3 groups (χ²=1.267,P=0.531). The results showed that there were significant differences in the integrity of ellipsoidal zone with different ranges of BCVA before and after 12 months treatment (χ²=20.145, 41.035;P=0.000, 0.000). Conclusions IVR could significantly improve the visual acuity of different patterns of DME, reduced the CFT, and had the best efficacy in the DRT group. There was relationship between the integrity of ellipsoidal zone and the visual acuity outcomes.

Citation： Fu Yudong, Meng Xuxia, Wang Ping, Liu Penghui, Wang Dabo. Efficacy of intravitreal injection of ranibizumab for different patterns of optical coherence tomography of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes. Chinese Journal of Ocular Fundus Diseases, 2017, 33(2): 129-133. doi: 10.3760/cma.j.issn.1005-1015.2017.02.005 Copy

1.	Bressler SB, Ayala AR, Bressler NM, et al. Persistent macular thickening after ranibizumab treatment for diabetic macular edema with vision impairment[J]. JAMA Ophthalmol, 2016, 134(3): 278-285. DOI: 10.1001/jamaophthalmol.2015.5346.
2.	Pieramici DJ, Wang PW, Ding B, et al. Visual and anatomic outcomes in patients with diabetic macular edema with limited initial anatomic response to ranibizumabin RIDE and RISE[J]. Ophthalmology, 2016, 123(6): 1345-1350. DOI: 10.1016/ j.ophtha.2016.02.007.
3.	Shimura M, Yasuda K, Yasuda M, et al. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema[J]. Retina, 2013, 33(4): 740-747. DOI: 10.1097/IAE. 0b013e31826b6763.
4.	Scholl S, Augustin A, Loewenstein A, et al. General pathophysiology of macular edema[J]. Eur J Ophthalmol, 2011, 21 (Suppl 6): S10-19. DOI: 10.5301/EJO.2010.6050.
5.	Erol N, Gursoy H, Kimyon S, et al. Vision, retinal thickness, and foveal avascular zone size after intravitreal bevacizumab fordiabetic macular edema[J]. Adv Ther, 2012, 29(4): 359-369. DOI: 10.1007/s12325-012-0009-9.
6.	Goebel W, Kretzchmar-Gross T. Retinal thickness in diabetic retinopathy: a study using optical coherence tomography (OCT)[J]. Retina, 2002, 22(6): 759-767.
7.	Sakamoto A, Nishijima K, Kita M, et al. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(10): 1325-1330. DOI: 10.1007/s00417-009-1107-5.
8.	Shimura M, Yasuda K, Nakazawa T, et al. Visual outcome after intravitreal triamcinolone acetonide depends on optical coherence tomographic patterns in patients with diffuse diabetic macular edema[J]. Retina, 2011, 31(4): 748-754. DOI: 10.1097/IAE. 0b013e3181f04991.
9.	Gardner TW, Antonetti DA, Barber AJ, et al. Diabetic retinopathy: more than meets the eye[J]. Surv Ophthalmol, 2002, 47 Suppl 2: S253-262.
10.	Titchenell PM, Antonetti DA. Using the past to inform he future: anti-VEGF therapy as a road map to develop novel therapies for diabetic retinopathy[J]. Diabetes, 2013, 62(6): 1808-1815. DOI: 10.2337/db12-1744.
11.	Alkuraya H, Kangave D, Abu El-Asrar AM. The correlation between optical coherence tomographic features and severity of retinopathy, macular thickness and visual acuity in diabetic macular edema[J]. Int Ophthalmol, 2005, 26(3): 93-99. DOI: 10.1007/ s10792-006-9007-8.
12.	Shimura M, Nakazawa T, Yasuda K, et al. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema[J]. Am J Ophthalmol, 2008, 145(5): 854-861. DOI: 10.1016/j.ajo.2007.12.031.
13.	Otani T, Kishi S. Correlation between optical coherence tomography and fluorescein angiography findings in diabetic macular edema[J]. Ophthalmology, 2007, 114(1): 104-107. DOI: 10.1016/j.ophtha. 2006.06.044.
14.	Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
15.	戎芳, 莫宾, 刘武. 神经上皮层脱离与否DME眼光感受器层完整性与视力的关系[J]. 国际眼科杂志, 2012, 12(12): 2361-2364. DOI: 10.3980/j.issn.1672-5123.2012.12.36.Rong F, Mo B, Liu W. Association between photoreceptor integrity and visual acuity in diabetic macular edema with or without serous retinal detachment[J]. Int Eye Sci, 2012, 12(12): 2361-2364. DOI: 10.3980/j.issn.1672-5123.2012.12.36.
16.	Shin HJ, Lee SH, Chung H, et al. Association between photoreceptor integrity and visual outcome in diabetic macular edema[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 250(1): 61-70. DOI: 10.1007/s00417-011-1774-x.

1. Bressler SB, Ayala AR, Bressler NM, et al. Persistent macular thickening after ranibizumab treatment for diabetic macular edema with vision impairment[J]. JAMA Ophthalmol, 2016, 134(3): 278-285. DOI: 10.1001/jamaophthalmol.2015.5346.
2. Pieramici DJ, Wang PW, Ding B, et al. Visual and anatomic outcomes in patients with diabetic macular edema with limited initial anatomic response to ranibizumabin RIDE and RISE[J]. Ophthalmology, 2016, 123(6): 1345-1350. DOI: 10.1016/ j.ophtha.2016.02.007.
3. Shimura M, Yasuda K, Yasuda M, et al. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema[J]. Retina, 2013, 33(4): 740-747. DOI: 10.1097/IAE. 0b013e31826b6763.
4. Scholl S, Augustin A, Loewenstein A, et al. General pathophysiology of macular edema[J]. Eur J Ophthalmol, 2011, 21 (Suppl 6): S10-19. DOI: 10.5301/EJO.2010.6050.
5. Erol N, Gursoy H, Kimyon S, et al. Vision, retinal thickness, and foveal avascular zone size after intravitreal bevacizumab fordiabetic macular edema[J]. Adv Ther, 2012, 29(4): 359-369. DOI: 10.1007/s12325-012-0009-9.
6. Goebel W, Kretzchmar-Gross T. Retinal thickness in diabetic retinopathy: a study using optical coherence tomography (OCT)[J]. Retina, 2002, 22(6): 759-767.
7. Sakamoto A, Nishijima K, Kita M, et al. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(10): 1325-1330. DOI: 10.1007/s00417-009-1107-5.
8. Shimura M, Yasuda K, Nakazawa T, et al. Visual outcome after intravitreal triamcinolone acetonide depends on optical coherence tomographic patterns in patients with diffuse diabetic macular edema[J]. Retina, 2011, 31(4): 748-754. DOI: 10.1097/IAE. 0b013e3181f04991.
9. Gardner TW, Antonetti DA, Barber AJ, et al. Diabetic retinopathy: more than meets the eye[J]. Surv Ophthalmol, 2002, 47 Suppl 2: S253-262.
10. Titchenell PM, Antonetti DA. Using the past to inform he future: anti-VEGF therapy as a road map to develop novel therapies for diabetic retinopathy[J]. Diabetes, 2013, 62(6): 1808-1815. DOI: 10.2337/db12-1744.
11. Alkuraya H, Kangave D, Abu El-Asrar AM. The correlation between optical coherence tomographic features and severity of retinopathy, macular thickness and visual acuity in diabetic macular edema[J]. Int Ophthalmol, 2005, 26(3): 93-99. DOI: 10.1007/ s10792-006-9007-8.
12. Shimura M, Nakazawa T, Yasuda K, et al. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema[J]. Am J Ophthalmol, 2008, 145(5): 854-861. DOI: 10.1016/j.ajo.2007.12.031.
13. Otani T, Kishi S. Correlation between optical coherence tomography and fluorescein angiography findings in diabetic macular edema[J]. Ophthalmology, 2007, 114(1): 104-107. DOI: 10.1016/j.ophtha. 2006.06.044.
14. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
15. 戎芳, 莫宾, 刘武. 神经上皮层脱离与否DME眼光感受器层完整性与视力的关系[J]. 国际眼科杂志, 2012, 12(12): 2361-2364. DOI: 10.3980/j.issn.1672-5123.2012.12.36.Rong F, Mo B, Liu W. Association between photoreceptor integrity and visual acuity in diabetic macular edema with or without serous retinal detachment[J]. Int Eye Sci, 2012, 12(12): 2361-2364. DOI: 10.3980/j.issn.1672-5123.2012.12.36.
16. Shin HJ, Lee SH, Chung H, et al. Association between photoreceptor integrity and visual outcome in diabetic macular edema[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 250(1): 61-70. DOI: 10.1007/s00417-011-1774-x.

Chinese Journal of Ocular Fundus Diseases

Efficacy of intravitreal injection of ranibizumab for different patterns of optical coherence tomography of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes

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