CLINICAL AND OPTICAL COHERENCE TOMOGRAPHY PREDICTORS OF VISUAL OUTCOME FOLLOWING INTRAVITREAL ANTI-VEGF THERAPY FOR DIABETIC MACULAR EDEMA

Abstract

Background: Diabetic macular edema is an important cause of visual impairment among patients with diabetes mellitus. Objective: To determine the clinical and optical coherence tomography predictors of visual outcome following intravitreal aflibercept therapy in patients with diabetic macular edema. Methods: This prospective observational study was conducted at Ophthalmology department, Services Hospital,Lahore from July 2022 to February 2023, ncluded 135 patients with diabetic macular edema treated with intravitreal aflibercept. Baseline demographic and clinical characteristics, best-corrected visual acuity, glycemic status, duration of diabetes and diabetic macular edema, and OCT findings were recorded.  Results: Among 135 patients with diabetic macular edema, the mean age was 57.8 ± 9.6 years, 56.3% were male, the mean duration of diabetes was 11.9 ± 5.7 years, and the mean HbA1c was 8.4 ± 1.3%. Intraretinal fluid/cystoid spaces were the most common OCT finding, present in 90.4% of patients, followed by hyperreflective foci in 54.1%, DRIL in 37.8%, subretinal fluid in 35.6%, ellipsoid zone disruption in 34.1%, and external limiting membrane disruption in 28.9%. Following intravitreal aflibercept therapy, mean BCVA improved significantly from 0.68 ± 0.24 to 0.42 ± 0.21 logMAR, while central subfield thickness decreased from 438.6 ± 82.4 µm to 312.7 ± 61.5 µm (both p < 0.001). Conclusion: Intravitreal aflibercept therapy was associated with significant functional and anatomical improvement in diabetic macular edema. Clinical factors and retinal microstructural OCT biomarkers, particularly DRIL and integrity of the ellipsoid zone and external limiting membrane, may be useful for predicting visual prognosis and individualizing patient management.