Document Detail

Behavior of SD-OCT-detected hyperreflective foci in the retina of anti-VEGF-treated patients with diabetic macular edema.
MedLine Citation:
PMID:  22836760     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Hyperreflective foci (HFs) are observable within the neurosensory retina in diabetic macular edema (DME) using spectral domain optical coherence tomography (SD-OCT). HFs have also been seen in wet age-related macular degeneration (AMD), although the origin is still unknown; however, they reduced significantly during anti-VEGF (vascular endothelial growth factor) therapy, and their baseline amount seemed to correlate with treatment success. In this study the behavior of HFs was evaluated during anti-VEGF therapy for DME.
METHODS: Fifty-one patients (mean age: 67 years) underwent SD-OCT before and one month after one anti-VEGF injection (ranibizumab: n = 30; bevacizumab: n = 21). The HFs were semiquantitatively counted, assigned to three groups (group A: HFs n = 1-10; group B: n = 11-20; group C: n > 20), and correlated to the course of visual acuity and foveal thickness (paired t-test). Additionally the baseline HbA1c was categorized and correlated to baseline HFs (Spearman Rho).
RESULTS: In all eyes, HFs of various amounts were detected in the foveal and parafoveal area. The mean number of HFs reduced significantly from 16.02 to 14.32 in all patients (P = 0.000), whereas foveal thickness reduced from 445.5 to 373.9 μm (P = 0.000) and visual acuity increased from 62.0 to 66.0 ETDRS letters (P = 0.003). Regarding the three HF groups, a reduction of the level stages was observed in 43.1% (stable: 54.9%; more: 2.0%). This reflects a HF distribution change from 31.4% to 62.7% (group A), from 45.1% to 31.4% (group B), and from 23.5% to 5.9% (group C). The HbA1c correlated significantly to the overall HF amount at baseline (0.880; P = 0.000); however, no distinct overall correlation was found between the HF reduction and the course of visual acuity or retinal thickness. Only in cases of complete edema resolution (25%) did HFs reduce significantly (P = 0.008).
CONCLUSIONS: As in wet AMD, HFs are frequently found in DME and behave similarly under anti-VEGF therapy. Thus, a HF reduction was observable mainly in cases of complete edema resolution; however, no distinct correlation with visual acuity was noticed, presumably mainly due to the enhanced inhomogeneity in the disease progress of DME. Interestingly, the baseline HF amount seems to correlate positively with HbA1c values indicating the severity of disease.
Carsten Framme; Paul Schweizer; Manfred Imesch; Sebastian Wolf; Ute Wolf-Schnurrbusch
Publication Detail:
Type:  Journal Article     Date:  2012-08-24
Journal Detail:
Title:  Investigative ophthalmology & visual science     Volume:  53     ISSN:  1552-5783     ISO Abbreviation:  Invest. Ophthalmol. Vis. Sci.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-27     Completed Date:  2012-12-03     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  7703701     Medline TA:  Invest Ophthalmol Vis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5814-8     Citation Subset:  IM    
University Eye Hospital Bern, Inselspital, Bern, Switzerland.
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MeSH Terms
Angiogenesis Inhibitors / administration & dosage*
Antibodies, Monoclonal, Humanized / administration & dosage
Diabetic Retinopathy / diagnosis,  drug therapy*,  metabolism
Exudates and Transudates / metabolism
Hemoglobin A, Glycosylated / metabolism
Intravitreal Injections
Macular Edema / diagnosis,  drug therapy*,  metabolism
Middle Aged
Retina / metabolism,  pathology*
Retrospective Studies
Tomography, Optical Coherence*
Vascular Endothelial Growth Factor A / antagonists & inhibitors*
Visual Acuity / physiology
Reg. No./Substance:
0/Angiogenesis Inhibitors; 0/Antibodies, Monoclonal, Humanized; 0/Hemoglobin A, Glycosylated; 0/VEGFA protein, human; 0/Vascular Endothelial Growth Factor A; 0/hemoglobin A1c protein, human; 0/ranibizumab; 2S9ZZM9Q9V/bevacizumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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