Decrease in the number of microaneurysms in diabetic macular edema after anti-vascular endothelial growth factor therapy
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Decrease in the number of microaneurysms in diabetic macular edema after anti-vascular endothelial growth factor therapy: implications for indocyanine green angiography-guided detection of refractory microaneurysms Kenichiro Mori 1 & Shigeo Yoshida 2 & Yoshiyuki Kobayashi 1 & Keijiro Ishikawa 1 & Shintaro Nakao 1 & Toshio Hisatomi 1 & Masatoshi Haruta 2 & Tatsuro Isihibashi 1 & Koh-hei Sonoda 1 Received: 20 September 2019 / Revised: 9 January 2020 / Accepted: 16 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We evaluated changes in the numbers of microaneurysms (MAs) on fluorescein angiography (FA) and indocyanine green angiography (IA) in eyes with diabetic macular edema (DME) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. Methods Twenty-one eyes of 16 patients with DME were included in this retrospective study. All patients received an initial loading dose of three monthly injections of anti-VEGF agents; thereafter, they received a pro re nata regimen for at least 12 months of follow-up. FA and IA images were obtained before and at 6 months after the initial injection. Results The median numbers of MAs significantly decreased from six (interquartile range [IQR] 3–7) MAs in early-phase FA, three (IQR 3–5) leaky MAs in late-phase FA, and two (IQR 1–4) MAs in late-phase IA at baseline to two (IQR 1–3) MAs in early-phase FA, one (IQR 0–2) leaky MA in late-phase FA, and one (IQR 0–2) MA in late-phase IA at 6 months (P < 0.0001 for all). Only the median numbers of MAs in late-phase IA at baseline and at 6 months were significantly higher in the recurrent DME group (13 eyes) than in the non-recurrent DME group (five eyes) (three [IQR 2–4] vs one [IQR 1–2], one [IQR 0.5–2] vs zero [P = 0.0185 and P = 0.009]). Conclusion Intravitreal injection of anti-VEGF agents reduced the numbers of MAs in patients with DME. The numbers of MAs detected by late-phase IA might be useful predictors of DME recurrence. Keywords Anti-vascular endothelial growth factor therapy . Diabetic retinopathy . Diabetic macular edema . Fluorescein angiography . Indocyanine green angiography . Microaneurysm
Introduction Diabetic retinopathy (DR) and associated diabetic macular edema (DME) are serious diabetes complications, which constitute the leading causes of blindness and visual impairment in working, aged adults [1, 2]. Worldwide, there are
* Shigeo Yoshida [email protected] 1
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2
Department of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
approximately 93 million people with DR, 21 million with DME, and 28 million with vision-threatening DR [2]. The pathogenesis of DME includes diabetic blood–retinal barrier breakdown and intraretinal fluid leakage from microaneurysms (MA); these changes are caused by angiogenesis, hypoxia, ischemia, oxygen-free radicals, and inflammatory mediat
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