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A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study.

Publication ,  Journal Article
Allingham, MJ; Mukherjee, D; Lally, EB; Rabbani, H; Mettu, PS; Cousins, SW; Farsiu, S
Published in: Transl Vis Sci Technol
March 2017

PURPOSE: We use semiautomated segmentation of fluorescein angiography (FA) to determine whether anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME) differentially affects microaneurysm (MA)-associated leakage, termed focal leakage, versus non-MA-associated leakage, termed diffuse leakage. METHODS: We performed a retrospective study of 29 subjects treated with at least three consecutive injections of anti-VEGF agents for DME (mean 4.6 injections; range, 3-10) who underwent Heidelberg FA before and after anti-VEGF therapy. Inclusion criteria were macula center involving DME and at least 3 consecutive anti-VEGF injections. Exclusion criteria were macular edema due to cause besides DME, anti-VEGF within 3 months of initial FA, concurrent treatment for DME besides anti-VEGF, and macular photocoagulation within 1 year. At each time point, total leakage was semiautomatically segmented using a modified version of our previously published software. Microaneurysms were identified by an expert grader and leakage within a 117 μm radius of each MA was classified as focal leakage. Remaining leakage was classified as diffuse leakage. The absolute and percent changes in total, diffuse, and focal leakage were calculated for each subject. RESULTS: Mean pretreatment total leakage was 8.2 mm2 and decreased by a mean of 40.1% (P < 0.0001; 95% confidence interval [CI], [-28.6, -52.5]) following treatment. Diffuse leakage decreased by a mean of 45.5% (P < 0.0001; 95% CI, [-31.3, -59.6]) while focal leakage decreased by 17.9% (P = 0.02; 95% CI, [-1.0, -34.8]). The difference in treatment response between focal and diffuse leakage was statistically significant (P = 0.01). CONCLUSIONS: Anti-VEGF treatment for DME results in decreased diffuse leakage but had relatively little effect on focal leakage as assessed by FA. This suggests that diffuse leakage may be a marker of VEGF-mediated pathobiology. Patients with predominantly focal leakage may be less responsive to anti-VEGF therapy. TRANSLATIONAL RELEVANCE: Fluorescein angiography can define focal and diffuse subtypes of diabetic macular edema and these may respond differently to anti-VEGF treatment.

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Published In

Transl Vis Sci Technol

DOI

ISSN

2164-2591

Publication Date

March 2017

Volume

6

Issue

2

Start / End Page

7

Location

United States

Related Subject Headings

  • 3212 Ophthalmology and optometry
  • 1113 Opthalmology and Optometry
  • 0903 Biomedical Engineering
 

Citation

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Chicago
ICMJE
MLA
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Allingham, M. J., Mukherjee, D., Lally, E. B., Rabbani, H., Mettu, P. S., Cousins, S. W., & Farsiu, S. (2017). A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study. Transl Vis Sci Technol, 6(2), 7. https://doi.org/10.1167/tvst.6.2.7
Allingham, Michael J., Dibyendu Mukherjee, Erin B. Lally, Hossein Rabbani, Priyatham S. Mettu, Scott W. Cousins, and Sina Farsiu. “A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study.Transl Vis Sci Technol 6, no. 2 (March 2017): 7. https://doi.org/10.1167/tvst.6.2.7.
Allingham MJ, Mukherjee D, Lally EB, Rabbani H, Mettu PS, Cousins SW, et al. A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study. Transl Vis Sci Technol. 2017 Mar;6(2):7.
Allingham, Michael J., et al. “A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study.Transl Vis Sci Technol, vol. 6, no. 2, Mar. 2017, p. 7. Pubmed, doi:10.1167/tvst.6.2.7.
Allingham MJ, Mukherjee D, Lally EB, Rabbani H, Mettu PS, Cousins SW, Farsiu S. A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study. Transl Vis Sci Technol. 2017 Mar;6(2):7.

Published In

Transl Vis Sci Technol

DOI

ISSN

2164-2591

Publication Date

March 2017

Volume

6

Issue

2

Start / End Page

7

Location

United States

Related Subject Headings

  • 3212 Ophthalmology and optometry
  • 1113 Opthalmology and Optometry
  • 0903 Biomedical Engineering