Prediction of Anti-VEGF Response in Diabetic Macular Edema After 1 Injection

Purpose: With multiple anti–vascular endothelial growth factor (VEGF) and steroid therapies available for diabetic macular edema (DME), there is a need for early determination of the best treatment for a particular patient to prevent irreversible vision loss from chronic DME. In this study, we classify patients as responders or nonresponders to anti-VEGF monotherapy in the treatment of DME after a single anti-VEGF injection. Methods: The study was designed as a single-center, retrospective, interventional case series. We included patients who received 3 consecutive monthly injections with the same anti-VEGF agent. We excluded patients who were treated for DME in the preceding 3 months with any form of anti-VEGF therapy. Visual acuity and central retinal thickness (CRT) data were followed for 1 year. Receiver operating characteristic (ROC) curve analysis was performed in order to identify the cutoff values for identifying responders. Results: One hundred seven eyes were reviewed, with 40 eyes of 34 patients meeting all inclusion criteria. Based on ROC curve analysis, a reduction in CRT by >15% at 1 month identified eyes that responded to treatment and had a >25% reduction in CRT at 3 months (sensitivity, 0.75; specificity, 0.92). Conclusion: Diabetic macular edema eyes that have early response to anti-VEGF treatment by reduction in CRT will have significant response to treatment by 3 months.