Abstract
Purpose
To understand subfoveal neurosensory detachment flattening and observe (SNF-Ob) strategy and its relationship with visual acuity in the management of centre-involved diabetic macular oedema (Ci-DMO).
Methods
This was a multicentric retrospective observational study. We reviewed data of 188 eyes of 130 patients who presented with Ci-DMO with subfoveal neurosensory detachment (NSD) and treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents or steroids. The primary outcome was best corrected visual acuity (BCVA) measured at the time of the first subfoveal neurosensory detachment flattening (SNF) and at the end of follow-up.
Results
Eyes that achieved 20/50 (LogMAR = 0.40) or better at first SNF had mean LogMAR BCVA 0.38 ± 0.21, 0.24 ± 0.11 and 0.21 ± 0.15 at baseline, at the time of first SNF, and at the end of the last follow-up respectively. Mean LogMAR BCVA significantly improved from baseline to first SNF (p < 0.0001; 95% CI 0.115–0.183) and at the end of the last follow-up (p < 0.0001; 95% CI 0.126–0.213) with a change of Early Treatment Diabetic Retinopathy Study (ETDRS) 10 letters. There was no significant difference in improvement in BCVA from the first SNF and at the end of the last follow-up (p = 0.0781; 95% CI −0.002 to 0.046).
Conclusions
Eyes presenting with Ci-DMO and subfoveal NSD are unlikely to improve at SNF with BCVA > 20/50 (LogMAR = 0.40). Further evidence is needed before the combination of good BCVA and SNF may be considered as endpoint of pharmacological therapy for DMO.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Lotus Eye Hospital and Institute, Coimbatore, Tamilnadu, India.
References
Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis. 2015;2:17.
Arevalo JF. Diabetic macular edema: current management 2013. World J Diabetes. 2013;4:231–3.
Boyer DS, Hopkins JJ, Sorof J, Ehrlich JS. Anti-vascular endothelial growth factor therapy for diabetic macular edema. Ther Adv Endocrinol Metab. 2013;4:151–69.
Weiss M, Sim DA, Herold T, Schumann RG, Liegl R, Kern C, et al. Compliance and adherence of patients with diabetic macular edema to intravitreal anti-vascular endothelial growth factor therapy in daily practice. Retina. 2018;38:2293–2300.
Roberts PK, Vogl WD, Gerendas BS, Glassman AR, Bogunovic H, Jampol LM, et al. Quantification of fluid resolution and visual acuity gain in patients with diabetic macular edema using deep learning: a post hoc analysis of a randomized clinical trial. JAMA Ophthalmol. 2020;138:945–53.
Bressler SB, Odia I, Glassman AR, Danis RP, Grover S, Hampton GR, et al. Changes in diabetic retinopathy severity when treating diabetic macular edema with ranibizumab: DRCR.net Protocol I 5-Year Report. Retina. 2018;38:1896–904.
Glassman AR, Baker CW, Beaulieu WT, Bressler NM, Punjabi OS, Stockdale CR, et al. DRCR Retina Network. Assessment of the DRCR retina network approach to management with initial observation for eyes with center-involved diabetic macular edema and good visual acuity: a secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2020;138:341–9.
Sharma A, Parachuri N, Kumar N, Kuppermann BD, Bandello F, Loewenstein A, et al. Subfoveal neurosensory detachment flattening and observe (SNF-Ob): a novel approach in diabetic macular edema management: a potential cost-effective treatment strategy to be explored. Ophthalmol Retin. 2019;3:1009–11.
Sophie R, Lu N, Campochiaro PA. Predictors of functional and anatomic outcomes in patients with diabetic macular edema treated with ranibizumab. Ophthalmology. 2015;122:1395–401.
Ozdemir H, Karacorlu M, Karacorlu S. Serous macular detachment in diabetic cystoid macular oedema. Acta Ophthalmol Scand. 2005;83:63–6.
Korobelnik JF, Lu C, Katz TA, Dhoot DS, Loewenstein A, Arnold J, et al. Effect of baseline subretinal fluid on treatment outcomes in VIVID-DME and VISTA-DME studies. Ophthalmol Retin. 2019;3:663–9.
Seo KH, Yu SY, Kim M, Kwak HW. Visual and morphologic outcomes of intravitreal ranibizumab for diabetic macular edema based on optical coherence tomography patterns. Retina. 2016;36:588–95.
Shimura M, Yasuda K, Yasuda M, Nakazawa T. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema. Retina. 2013;33:740–7.
Kaya M, Karahan E, Ozturk T, Kocak N, Kaynak S. Effectiveness of intravitreal ranibizumab for diabetic macular edema with serous retinal detachment. Korean J Ophthalmol. 2018;32:296–302.
Kwon JW, Kim B, Jee D, Cho YK. Aqueous humor analyses of diabetic macular edema patients with subretinal fluid. Sci Rep. 2021;11:20985.
Baker CW, Glassman AR, Beaulieu WT, Antoszyk AN, Browning DJ, Chalam KV, et al. DRCR Retina Network. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321:1880–94.
Maturi RK, Glassman AR, Liu D, Beck RW, Bhavsar AR, Bressler NM, et al. Diabetic Retinopathy Clinical Research Network. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a DRCR network phase 2 randomized clinical trial. JAMA Ophthalmol. 2018;136:29–38.
Acknowledgements
BDK acknowledges an unrestricted grant from Research to Prevent Blindness to the Gavin Herbert Eye Institute at the University of California, Irvine.
Author information
Authors and Affiliations
Contributions
AS: conception, analysis, drafting, integrity check, final approval. TW, CDR, CMGC, AL, DZ, DG, AH, SO, HBO, NP, NK, BDK, FB, GQ drafting, revision, analysis, integrity check.
Corresponding author
Ethics declarations
Competing interests
AS: consultant: for Novartis, Allergan, Bayer, Lupin, Intas, Biogen. TW: None. CDR- consultant: 4DMT, Adverum, Allergan, Annexon, Apellis, Aviceda, Bausch and Lomb, Boehringer-Ingelheim, Clearside, Eyepoint, Genentech/Roche, Iveric, Janssen, Kodiak, Merck, NGM, Novartis, Ocugen, Opthea, Regenxbio, Stealth, Thea, Zeiss and receives research support from 4DMT, Adverum, Allergan, Annexon, Apellis, Eyepoint, Genentech/Roche, Iveric, Janssen, Kodiak, NGM, Novartis, Ocugen, Opthea, Regenxbio, Regeneron. CMGC: Novartis, Bayer, Roche, Boehringer-Ingelheim, Topcon, Zeiss and Chui Ming Gemmy Cheung is a member of the Eye editorial board. AL reports other from Allergan, other from Novartis, other from Roche, other from Notal Vision, other from Forsightslabs, other from Beyeonics, other from Bayer Health Care. DZ: consultant for Novartis, Abbvie, Bayer and Roche. DG: None. AH: None. SO: consultant for Novartis, Allergan, Bayer, Bauch & Lomb. HBÖ: None. NP: None. NK: None. BDK: CLINICAL RESEARCH: Alcon, Alimera, Allegro, Allergan, Apellis, Clearside, Genentech, GSK, Ionis, jCyte, Novartis, Regeneron, ThromboGenics; consultant: Alimera, Allegro, Allergan, Cell Care, Dose, Eyedaptic, Galimedix, Genentech, Glaukos, Interface Biologics, jCyte, Novartis, Ophthotech, Regeneron, Revana, Theravance Biopharma. FB: consultant: Allergan, Bayer, Boehringer- Ingelheim, FidiaSooft, Hofmann La Roche, Novartis, NTC Pharma, Sifi, Thrombogenics, Zeiss. GQ: consultant: Alimera Sciences, Allegro, Allergan Inc, Amgen, Bayer Shering-Pharma, Baush & Lomb, Boehringer-Ingelheim, CenterVue, Heidelberg, KBH, LEH Pharma, Lumithera, Nevacar, Novartis, Roche, Sandoz, Sifi, Sooft-Fidia, Topcon, Thea, Zeiss.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sharma, A., Wakabayashi, T., Regillo, C.D. et al. Subfoveal neurosensory detachment flattening and observe (SNF-Ob) approach for the management of Ci-DMO - a multicentric study. Eye 38, 3272–3278 (2024). https://doi.org/10.1038/s41433-024-03275-y
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-024-03275-y
