Correlation Between OCT Biomarkers And Non-response To Anti-VEGF Therapy In Patients With Diabetic Macular Edema

Objective: To analyze the correlation between OCT(Optical Coherence Tomography,OCT)biomarkers and non-response to anti-vascular endothelial growth factor(VEGF)treatment in patients with diabetic macular edema(DME),and to explore whether OCT biomarkers can be used as predictors of anti-VEGF treatment in these patients.Methods:the clinical data of patients with diabetic retinopathy with macular edema diagnosed for the first time in our hospital from February 2020 to February 2022 were analyzed retrospectively.all patients received Anti-VEGF therapy of 3+PRN and were followed up for 12 months.They were divided into response group and non-response group according to the 12-month follow-up.The criterion is that the central macular thickness(CMT)of the patients on OCT is less than 20% less than that before treatment as the response group,otherwise it is the non-response group.The spectral domain optical coherence tomography(SD-OCT)and systemic condition of the two groups before the first treatment were analyzed.The lesions in a wide range of 1mm centered on the macular fovea were observed: retinal outer nuclear layer cyst,inner retinal nuclear layer cyst,ellipsoidzone(EZ)and external limiting membrane(ELM)continuity(complete continuity,discontinuity,loss)and hyperreflective foci(HF).The existence of HF,the number of high reflex points(a few 2-10,moderate 11-20,a large number > 21),disorganization of retinal inner layer(DRIL),subretinal fluid(SRF).The whole body indexes included sex,age,course of diabetes,hypertension,dyslipidemia,glycosylated hemoglobin(Hb1Ac),body mass index(BMI),blood urea,creatinine and so on.Univariate analysis compared the differences of baseline OCT biomarkers and systemic condition indexes between the two groups.The variables with significant statistical differences in univariate analysis were included in multivariate Logistic regression analysis to explore the risk factors of non-response to anti-VEGF treatment in DME patients,and to analyze whether they can predict the prognosis of anti-VEGF therapy in DME patients.During the treatment,the macular foveal thickness(CMT)was collected before and 1 month,3 months,6 months and 12 months after anti-VEGF treatment,and the differences of CMT at different time points before and during treatment were compared between the two groups by repeated measurement analysis of variance.Results: a total of 51 eyes of 51 patients with DME were included in the study,including 30 cases(58.8%)in the response group and 21 cases(41.2%)in the non-response group.Univariate analysis compared the differences of body mass index and OCT biomarkers at baseline between the two groups.It was found that there were significant differences in body mass index(BMI),retinal outer nuclear layer cyst,high reflex point and inner retinal structure disorder between the two groups.The variables with statistical differences in the above univariate analysis were included in multivariate logistic regression analysis.Body mass index(BMI)(OR=1.33,95%CI1.03-1.7),high reflex point(OR=7.54,95%CI1.25-45.29)and retinal inner layer disorder(OR=7.26,95%CI1.31-40.2)were risk factors for non-response to Anti-VEGF therapy in DME patients.There was a significant difference in the total mean of CMT between the response group and the non-response group at different time points after treatment.The postoperative CMT in the non-response group was higher than that in the response group.There was a significant difference in CMT between the two groups.Compared with the baseline,the CMT of 1 month,3 months,6 months and 12 months after operation in the response group was better than that before treatment,while the CMT of the patients in the non-response group at 1 month,3 months and 6 months after operation was better than that before treatment(P < 0.05).There was no significant difference between CMT and baseline 12 months after operation.Conclusion: body mass index(BMI),retinal inner structure disorder and high reflex point are risk factors for non-response to anti-VEGF therapy in patients with DME.These OCT biomarkers can predict the prognosis of DME patients treated with anti-VEGF.