DRIL Presence Predictive of VA Improvement in Patients with Macular Edema, RVO

JULY 23, 2018
Matt Hoffman
Amy S. Babiuch, MD
The presence of disorganization of inner retinal layers (DRIL) at baseline, as well as changes in DRIL burden during treatment with anti-vascular endothelial growth factor (anti-VEGF), can be a prognostic indicator for improvement in Early Treatment Diabetic Retinopathy Study (ETDRS) score in patients with macular edema secondary to retinal vein occlusion (RVO).

Presented at the American Society of Retina Specialists (ASRS) annual meeting in Vancouver, British Columbia, by Amy S. Babiuch, MD, an ophthalmologist at Cleveland Clinic’s Strongsville Family Health Center, the retrospective chart review included data from 147 eyes of an equivalent number of patients that presented with treatment-naïve RVO—either branch (n = 72), or central/hemispheric (n = 75)—with at least 1 year follow-up.

DRIL scores were evaluated with scores 0-3 based on 3 horizontal raster scans centered at the fovea and divvied into 3 regions: a 1-mm zone, a central 2-mm zone excluding the 1-mm zone, and any area outside of those zones. “These DRIL scores were then compared to each of the ETDRS scores at each time point,” Babiuch said. At baseline, 61.9% (n = 91) of patients had DRIL presence.

The final results showed a mean change of 11.8 ETDRS letters at 12 months. After 6 months, the majority of patients, 59% experienced a reduction in DRIL, but by 12 months that trend decreased slightly.

In the group with branch RVO, presence of any DRIL was associated with a lower baseline score of ETDRS letters (P = .002), while the baseline scores for those with central/hemispheric RVO were not significant (P = .044). Over the course of the 12-month study period, DRIL was reduced in 51% of patients, increased in 23.1% of patients, and remained unchanged in 13.6% of patients. In total, no DRIL was observed in 28.6% of patients.

Additionally, the number of anti-VEGF injections significantly decreased from the 6-month mark to the 12-month mark for all groups. For the branch RVO group, which was administered a mean 5.2 injections at baseline, decreased to 3.47 at 6 months, then 1.7 at 12 months. Likewise, the central/hemispheric RVO group decreased the mean number of anti-VEGF injections from 5.1 at baseline to 3.28 at month 6, then 1.8 at month 12.

A continued DRIL presence was predictive of less visual acuity gain with treatment in the branch RVO group up to the 6-month mark (P = .025). In the patients with central/hemispheric RVO, increasing DRIL scores at any time was predictive of reduced visual acuity improvement at 6 months (P = .002) and 12 months (P <.001).

“There was a definitive correlation with visual acuity in both diabetic macular edema and RVO,” Babiuch said. “While DRIL is not the biomarker, it is certainly useful in conjunction with other information, and should prompt continued treatment with anti-VEGF agents when it is present.”

The study, “Disorganization of Retinal Inner Layers Predicts Visual Acuity Response to Anti-VEGF Therapy for Macular Edema Secondary to Retinal Vein Occlusion,” was presented in a symposium at the 36th annual ASRS meeting.

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