Prediction of Anti-VEGF Response in Diabetic Macular Edema After 1 Injection

Abstract

Purpose: With multiple anti-vascular endothelial growth factor and steroid therapies available for diabetic macular edema (DME), there is a need for early determination of the best treatment for a particular patient to prevent irreversible vision loss from chronic DME. In this study, we classify patients as responders or non-responders to anti-vascular endothelial growth factor (VEGF) monotherapy in the treatment of DME after a single anti-VEGF injection.

Methods: The study was designed as a single center, retrospective, interventional case series. We included patients who received 3 consecutive monthly injections with the same anti-VEGF agent. We excluded patients who were treated for DME in the preceding 3 months with any form of anti-VEGF therapy. Visual acuity and central retinal thickness (CRT) data were followed for one year. Receiver operating characteristic (ROC) curve analysis was performed in order to identify cutoff values for identifying responders.

Results: 107 eyes were reviewed, with 40 eyes of 34 patients meeting all inclusion criteria. Based on ROC curve analysis, a reduction in CRT by > 15% at 1-month, identified eyes that responded to treatment and had a >25% reduction in CRT at 3-months (sensitivity 0.75, specificity 0.92).

Conclusion: DME eyes that have early response to anti-VEGF treatment by reduction in CRT will have significant response to treatment by 3 months.

Keywords: Anti-VEGF; Diabetic Macular Edema; Diabetic Retinopathy; Receiver Operating Characteristics Curve; Vascular Endothelial Growth Factor.

Conflict of interest statement

Disclosures: None of the authors report any disclosures or conflicts of interest.

Figures

Figure 1

Visual acuity change in patients with diabetic macular edema on anti–vascular endothelial growth factor therapy during the first 12 months of treatment. LogMAR, logarithm of the minimum angle of resolution.

Figure 2

Change in central foveal thickness in patients with diabetic macular edema on anti–vascular endothelial growth factor therapy during the first 12 months of treatment.

Figure 3

Empirical receiver operator curve for anatomic response after a single anti-VEGF injection in patients with diabetic macular edema on anti-VEGF therapy. VEGF, vascular endothelial growth factor.