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Background <p>Swept-source OCT (SS-OCT) and OCT angiography (SS-OCTA) enable high-resolution assessment of retinal and choroidal biomarkers in diabetic macular edema (DME). However, prospective analyses of how these biomarkers correlate before and after anti-VEGF therapy in treatment-naïve eyes are limited. The aim of this study was to prospectively evaluate biomarker correlations following aflibercept treatment using state-of-the-art, high-resolution imaging with SS-OCT and SS-OCTA during 4 months of follow-up.</p> Methods <p>This was a prospective interventional case series that included 28 eyes from 25 treatment-naïve patients with DME. All eyes received three monthly intravitreal aflibercept injections. Patients were reassessed one month after the loading phase (4-month visit). The evaluated biomarkers included best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), vessel density (VD), and avascular area of the superficial plexus (AASP) and deep plexus (AADP). Pre- and posttreatment values were compared, and correlations were analyzed using Pearson’s or Spearman’s methods.</p> Results <p>Significant changes in BCVA (0.7250 ± 0.23 to 0.3957 ± 0.21; <i>p</i> &lt; 0.000), CMT μm (339.04 ± 66.19 to 265.21 ± 55.75; <i>p</i> &lt; 0.000), CCT μm (221.71 ± 69.69 to 209.07 ± 70.92; <i>p</i> &lt; 0.000), VD (17.90 ± 7.82 to 15.35 ± 5.80; <i>p</i> &lt; 0.038), AASP μm<sup>2</sup> (235,374 ± 91,299 to 157,326 ± 77,815; <i>p</i> &lt; 0.000) and AADP μm<sup>2</sup> (1996,335 ± 1,000,047 to 362,161 ± 277,225; <i>p</i> &lt; 0.000) were detected. Very high correlations were observed for the CCT pre vs CCT post (<i>r</i> = 0.98; <i>p</i> &lt; 0.001), and AADP pre vs AADP reduction (<i>r</i> = −0.93; <i>p</i> &lt; 0.001), high correlation: VD pre vs VD reduction (<i>r</i> = −0.72; <i>p</i> &lt; 0.001. In total, 2 correlations were very high, 1 high, 4 moderate, and 9 were low; all the correlations were statistically significant.</p> Conclusions <p>Treatment-naïve DME eyes treated with aflibercept showed significant structural, vascular, and functional improvements, with several baseline biomarkers acting as potential predictive indicators of posttreatment outcomes. The very high correlation of CCT and AADP and the high correlation of VD suggest that SS-OCT and SS-OCTA can provide clinically useful information for identifying how patients will respond to treatment. These correlations support the role of SS-OCT and SS-OCTA not only as diagnostic tools but also as potential predictive indicators of therapeutic response, facilitating more personalized DME management in clinical practice. Notably, this is the first prospective study to evaluate correlations between SS-OCT and SS-OCTA biomarkers in naïve DME eyes treated with aflibercept.</p>

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Analysis of correlations between biomarkers assessed with swept-source OCT and OCT angiography in naïve patients with diabetic macular edema treated with aflibercept: a prospective study

  • 期刊论文

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  • 发表日期：

    2025年12月17日

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  • Marcussi Palata Rezende,
  • Fernanda Atoui Faria,
  • Daniel Prado Beraldo,
  • Julia Polido,
  • Rubens Belfort Jr,
  • Thiago Cabral

摘要

Background

Swept-source OCT (SS-OCT) and OCT angiography (SS-OCTA) enable high-resolution assessment of retinal and choroidal biomarkers in diabetic macular edema (DME). However, prospective analyses of how these biomarkers correlate before and after anti-VEGF therapy in treatment-naïve eyes are limited. The aim of this study was to prospectively evaluate biomarker correlations following aflibercept treatment using state-of-the-art, high-resolution imaging with SS-OCT and SS-OCTA during 4 months of follow-up.

Methods

This was a prospective interventional case series that included 28 eyes from 25 treatment-naïve patients with DME. All eyes received three monthly intravitreal aflibercept injections. Patients were reassessed one month after the loading phase (4-month visit). The evaluated biomarkers included best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), vessel density (VD), and avascular area of the superficial plexus (AASP) and deep plexus (AADP). Pre- and posttreatment values were compared, and correlations were analyzed using Pearson’s or Spearman’s methods.

Results

Significant changes in BCVA (0.7250 ± 0.23 to 0.3957 ± 0.21; p < 0.000), CMT μm (339.04 ± 66.19 to 265.21 ± 55.75; p < 0.000), CCT μm (221.71 ± 69.69 to 209.07 ± 70.92; p < 0.000), VD (17.90 ± 7.82 to 15.35 ± 5.80; p < 0.038), AASP μm2 (235,374 ± 91,299 to 157,326 ± 77,815; p < 0.000) and AADP μm2 (1996,335 ± 1,000,047 to 362,161 ± 277,225; p < 0.000) were detected. Very high correlations were observed for the CCT pre vs CCT post (r = 0.98; p < 0.001), and AADP pre vs AADP reduction (r = −0.93; p < 0.001), high correlation: VD pre vs VD reduction (r = −0.72; p < 0.001. In total, 2 correlations were very high, 1 high, 4 moderate, and 9 were low; all the correlations were statistically significant.

Conclusions

Treatment-naïve DME eyes treated with aflibercept showed significant structural, vascular, and functional improvements, with several baseline biomarkers acting as potential predictive indicators of posttreatment outcomes. The very high correlation of CCT and AADP and the high correlation of VD suggest that SS-OCT and SS-OCTA can provide clinically useful information for identifying how patients will respond to treatment. These correlations support the role of SS-OCT and SS-OCTA not only as diagnostic tools but also as potential predictive indicators of therapeutic response, facilitating more personalized DME management in clinical practice. Notably, this is the first prospective study to evaluate correlations between SS-OCT and SS-OCTA biomarkers in naïve DME eyes treated with aflibercept.