Optical Coherence Tomographic Patterns in Diabetic Macula Edema Can Predict the Effects of Intravitreal Bevacizumab Injection as Primary Treatment

Purpose: To identify optical coherence tomography (OCT) patterns in diabetic macular edema (DME) that were predictive of visual outcomes after intravitreal bevacizumab (IVB) injection. Methods: This was a retrospective study. We examined 31 eyes (24 patients) with clinically significant macular edema that received IVB injections along with macular OCT data. The eyes were categorized into 4 groups by using OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). Changes in retinal thickness, retinal volume, and visual acuity (VA) after IVB injection were compared on the basis of OCT patterns. Results: After IVB injections, changes in VA logarithm of the minimum angle of resolution were -0.06 +/- 0.36, -0.26 +/- 0.26, 0.09 +/- 0.13, and -0.08 +/- 0.15, respectively, for DRT, CME, SRD, and VMIA patterns. Central macular thickness decreased by 70.5 +/- 105.5, 110.67 +/- 97.28, 181 +/- 125.87, and 24.25 +/- 77.12 mu m for the DRT, CME, SRD, and VMIA patterns, respectively. The CME group was associated with a greater reduction in retinal thickness (P = 0.009) and volume (P = 0.027) with superior VA improvement (P=0.012) as compared with the DRT, SRD, and VMIA groups. Conclusions: Patients with CME gained greater improvement in visual acuity and macular thickness and volume after IVB injection had been administered as the primary treatment for DME, as compared with other patients. The OCT patterns of DME may indicate the appropriate treatment; we consider these patterns to be prognostic of the response to IVB injection for macular edema.