A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study.
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We use semiautomated segmentation of fluorescein angiography (FA) to determine whether anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME) differentially affects microaneurysm (MA)-associated leakage, termed focal leakage, versus non-MA-associated leakage, termed diffuse leakage.We performed a retrospective study of 29 subjects treated with at least three consecutive injections of anti-VEGF agents for DME (mean 4.6 injections; range, 3-10) who underwent Heidelberg FA before and after anti-VEGF therapy. Inclusion criteria were macula center involving DME and at least 3 consecutive anti-VEGF injections. Exclusion criteria were macular edema due to cause besides DME, anti-VEGF within 3 months of initial FA, concurrent treatment for DME besides anti-VEGF, and macular photocoagulation within 1 year. At each time point, total leakage was semiautomatically segmented using a modified version of our previously published software. Microaneurysms were identified by an expert grader and leakage within a 117 μm radius of each MA was classified as focal leakage. Remaining leakage was classified as diffuse leakage. The absolute and percent changes in total, diffuse, and focal leakage were calculated for each subject.Mean pretreatment total leakage was 8.2 mm2 and decreased by a mean of 40.1% (P < 0.0001; 95% confidence interval [CI], [-28.6, -52.5]) following treatment. Diffuse leakage decreased by a mean of 45.5% (P < 0.0001; 95% CI, [-31.3, -59.6]) while focal leakage decreased by 17.9% (P = 0.02; 95% CI, [-1.0, -34.8]). The difference in treatment response between focal and diffuse leakage was statistically significant (P = 0.01).Anti-VEGF treatment for DME results in decreased diffuse leakage but had relatively little effect on focal leakage as assessed by FA. This suggests that diffuse leakage may be a marker of VEGF-mediated pathobiology. Patients with predominantly focal leakage may be less responsive to anti-VEGF therapy.Fluorescein angiography can define focal and diffuse subtypes of diabetic macular edema and these may respond differently to anti-VEGF treatment.
Published Version (Please cite this version)10.1167/tvst.6.2.7
Publication InfoCousins, Scott; Mettu, Priyatham; Farsiu, Sina; Allingham, Michael; Mukherjee, Dibyendu; Lally, Erin B; & Rabbani, Hossein (2017). A Quantitative Approach to Predict Differential Effects of Anti-VEGF Treatment on Diffuse and Focal Leakage in Patients with Diabetic Macular Edema: A Pilot Study. Translational vision science & technology, 6(2). pp. 7. 10.1167/tvst.6.2.7. Retrieved from https://hdl.handle.net/10161/17288.
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Assistant Professor of Ophthalmology
Michael Allingham, MD PhD is a retina fellowship-trained clinician scientist with expertise in the diagnosis and treatment of medical conditions affecting the retina. Trained in the interpretation of retinal vascular imaging techniques, including video fluorescein angiography (FA) and indocyanine green (ICG) angiography, he specializes in the use of these imaging studies to guide injection and laser-based treatment of disease. His research focuses on using a mouse model of retinal edema to el
Robert Machemer, M.D. Professor of Ophthalmology
Scott W. Cousins, M.D. is currently the Robert Machemer, M.D. Professor of Ophthalmology and Immunology, Vice Chair for Research, and Director of the Duke Center for Macular Diseases at Duke Eye Center. As Vice Chair, he oversees all basic science research as well as the Ophthalmology Site-Based Research Group, which administrates clinical research for Duke Eye Center. Dr. Cousins is also Medical Director of Hospital-Based Imaging and Procedures for Duke Eye Center. Dr. Cousi
Paul Ruffin Scarborough Associate Professor of Engineering
I am the director of the Vision and Image Processing (VIP) Laboratory. Along with my colleagues, we investigate how to improve early diagnostic methods and find new imaging biomarkers of ocular and neurological diseases in adults (e.g. age-related macular degeneration, diabetic retinopathy, Glaucoma, Alzheimer) and children (e.g. retinopathy or prematurity). We also develop automatic artificial intelligence machine learning and deep learning algorithms to detect/segment/quantify anatomical/patho
Assistant Professor of Ophthalmology
Dr. Mettu, MD is a fellowship-trained ophthalmologist, specializing in the diagnosis, treatment, and research of macular diseases. His clinical practice focuses on the medical treatment of diabetic retinopathy, age-related macular degeneration, and retinal vascular diseases. He has an active clinical and laboratory research program at the Duke Center for Macular Diseases as part of the National Institutes of Health-sponsored K12 program. Dr. Mettu is actively involved in clinical trials of ne
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