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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

  • Retinal Disorders
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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.

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Acknowledgments

We thank Ryan Chastain-Gross, Ph.D., from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This research is supported in part by grants from the JSPS KAKENHI Grant Number 18K09450, Global Ophthalmology Awards Program (GOAP), a Bayer-sponsored initiative committed to supporting ophthalmic research across the world.

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Authors and Affiliations

  1. Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kenichiro Mori, Yoshiyuki Kobayashi, Keijiro Ishikawa, Shintaro Nakao, Toshio Hisatomi, Tatsuro Isihibashi & Koh-hei Sonoda

  2. Department of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan

    Shigeo Yoshida & Masatoshi Haruta

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  1. Kenichiro Mori
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Correspondence to Shigeo Yoshida.

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Mori, K., Yoshida, S., Kobayashi, Y. et al. 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. Graefes Arch Clin Exp Ophthalmol 258, 735–741 (2020). https://doi.org/10.1007/s00417-020-04608-9

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