Evaluation of bioclinical markers to predict short term response to intravitreal anti-VEGF in treatment-naive diabetic macular edema and the “Fried Egg” sign : a novel OCT feature

Abstract

Abstract Objective: To determine the incidence of suspended scattering particles in motion (SSPiM) and to assess baseline bioclinical markers in treatment-naive diabetic macular edema (DME) which can predict the short term response to intravitreal anti-VEGF. Design: Prospective observational study. Participants: Treatment-naive DME patients from January 2022 to June 2022 were included in the study. Methods: Treatment-naive DME cases were included and followed up for three months. Best corrected visual acuity (BCVA), SSPiM, HbA1c levels, hyperreflective dots (HRD), sub retinal fluid (SRF), central subfoveal thickness (CSFT), optical density ratio (ODR) of the largest cyst near the fovea, type of cyst (uniformly hyperreflective or fragmented intracystic hyperreflectivity called "fried egg" sign) at baseline were studied to predict response to treatment after anti-VEGF. Results: 123 eyes of 88 patients were included in the study. Incidence of SSPiM was 64.5%.The mean incidence of poor responders was 35%. BCVA, ODR, hyperreflective cysts and presence of SSPiM were not associated with response to anti-VEGF. Higher CSFT, SRF, higher number of HRD, presence of SSPiM in the outer nuclear layer (ONL) and outer plexiform layer (OPL) were associated with short term good response to anti-VEGF. High HbA1c and presence of "fried egg" sign in the hyperreflective cysts were associated with poor response. Conclusion: Higher CSFT, SSPiM in the ONL and OPL, and higher HRD were associated with good response to antI-VEGF. High HbA1c and "fried egg" sign was associated with poor response to anti-VEGF. BCVA, presence of SSPiM and ODR were not associated with anti-VEGF response.