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Choroidal thickness changes stratified by outcome in real-world treatment of diabetic macular edema

  • Retinal Disorders
  • Published:
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Abstract

Purpose

The aim of this study was to evaluate subfoveal choroidal thickness (SFCT) as a marker of outcome in real-world treatment of diabetic macular edema (DME) and to correlate it with choroidal thicknesses (CT) collected around the fovea.

Methods

Prospective interventional case series included a total of 126 eyes from 126 patients with recently diagnosed DME treated with a 3-monthly loading dose of ranibizumab or aflibercept and PRN thereafter until 24 months (M). CT was manually measured in the central 3500 μm area, subfoveally (SFCT), at 1750 μm right and left from the center in the horizontal plane and at 1750 μm up and down from the center in the vertical plane, by OCT. Anatomic (10% decrease in central retinal thickness) and functional (gain ≥ 5 letters) responses were assessed using univariate and multivariate analyses. The areas under ROC curves were used to assess whether baseline SFCT was a predictor of outcome.

Results

CT significantly decreased in all follow-ups (3 months after the 3 injections’ loading dose (3M), 6 months (6M), 12 months (12M), 18 months (18M), 24 months (24M)). SFCT and other CT parameters are correlated. SFCT decrease from baseline was related with treatment (p = 0.003 to p < 0.001) but not with anatomic (3M, p = 0.858; 6M p = 0.762) or functional response (3M, p = 0.746; 6M, p = 0.156). SFCT was not found to be predictive of anatomic (AUC = 0.575, p = 0.172) or functional (AUC = 0.515, p = 0.779) outcome.

Conclusions

SFCT is a reliable marker of choroidal thickness. Baseline SFCT decreased with anti-VEGF treatment but did not predict DME outcome.

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Funding

This work is funded by the Portuguese Foundation for Science and Technology (Fundação para a Ciência e a Tecnologia, FCT), Strategic Project (UID/NEU/04539/2013), and COMPETE-FEDER (POCI-01-0145-FEDER-007440). EJC was financially supported by the FCT Postdoctoral Fellowship SFRH/BPD/93672/2013, through the European Union and National funds and co-funded by Human Capital Operating Programme (Programa Operacional do Capital Humano, POCH). The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal

    António Campos, Elisa J. Campos, Miguel Patrício, António Francisco Ambrósio & Rufino Silva

  2. CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal

    António Campos, Elisa J. Campos, Anália do Carmo, Miguel Patrício & António Francisco Ambrósio

  3. Department of Ophthalmology, Leiria Hospital, Leiria, Portugal

    António Campos & João P. Castro de Sousa

  4. Clinical Pathology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

    Anália do Carmo

  5. Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Miguel Patrício

  6. Medical Sciences Department, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    João P. Castro de Sousa

  7. Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

    Rufino Silva

  8. Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal

    Rufino Silva

Authors
  1. António Campos
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  2. Elisa J. Campos
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  3. Anália do Carmo
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  4. Miguel Patrício
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  5. João P. Castro de Sousa
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  6. António Francisco Ambrósio
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Contributions

AC: acquisition, analysis, interpretation of data, and drafting of the manuscript. EC: interpretation of data, administrative, technical, editorial, and submission support. Do Carmo: data collection, scoring, and statistical analysis. MP: mathematics and statistical analysis. JS: critical revision. AA: revision of the manuscript and interpretation of data. RS: concept, design, supervision, and revision.

Corresponding author

Correspondence to António Campos.

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Conflict of interest

Rufino Silva is a member of the Advisory Boards for Bayer, Alcon, Alimera, Allergan, Novartis, and Thea. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Campos, A., Campos, E.J., do Carmo, A. et al. Choroidal thickness changes stratified by outcome in real-world treatment of diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 256, 1857–1865 (2018). https://doi.org/10.1007/s00417-018-4072-z

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  • DOI: https://doi.org/10.1007/s00417-018-4072-z

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