Prognostic value of OCT biomarkers and systemic factors for early and long term anatomical treatment response in diabetic macular edema
- 1Department of Ophthalmology, Korgan State Hospital, 11A Bağ Street, Dolunay Neighborhood, Fatsa, Ordu Turkey
- 2Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Abstract
Background: To evaluate the prognostic value of baseline optical coherence tomography (OCT) biomarkers and systemic factors for early and long-term anatomical response to anti-VEGF therapy in diabetic macular edema (DME).
Methods: This retrospective study included 164 eyes from 105 patients with type 2 diabetes and DME who received three monthly loading doses of intravitreal bevacizumab (January 2013 to April 2024) and were subsequently managed with a pro re nata (PRN) regimen using standard retreatment criteria. Completion of the loading phase (minimum follow-up, 3 months) was required for inclusion. Anatomical response was assessed after the loading phase (early response) and at final follow-up (long-term response); eyes were classified as full, partial, or non-responders based on CMT and OCT morphology. Baseline demographic, systemic, and OCT characteristics were analyzed using generalized estimating equation (GEE) logistic regression to account for inter-eye correlation, followed by one-eye-per-patient sensitivity analyses.
Results: After loading, 10 eyes (6.1%) were full responders, 72 (43.9%) partial responders, and 82 (50.0%) non-responders; 90% of early full responders maintained full response at final follow-up. In multivariable GEE analyses, higher baseline CMT, higher hyperreflective foci (HRF) count, and hyperreflective intraretinal material were independently associated with early anatomical response under the original percentage-reduction outcome definition; for long-term response, baseline CMT was only nominally associated and did not survive correction for multiple testing, and DRIL, EZ/ELM defect, and intraretinal cyst size were not significant. Both models showed moderate discrimination after bootstrap optimism correction (AUC 0.751 and 0.757, respectively). Sensitivity analyses across eye-selection strategies were consistent for baseline CMT, DRIL, EZ/ELM defect, and hyperreflective material, but intraretinal cyst size was unstable; all associations were sensitive to how anatomical response was defined.
Conclusions: Baseline OCT biomarkers showed candidate associations with anatomical response, but several, including the hyperreflective-material association, were not reproduced when the outcome was redefined using continuous final CMT or an absolute CMT threshold, despite robustness within the primary model. Discrimination was moderate (optimism-corrected AUC 0.75–0.76). These findings identify candidate prognostic OCT biomarkers requiring external validation before clinical application.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12886-026-05350-2.
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BibTeX
@article{ozdemir2026prognostic,
title = {{Prognostic value of OCT biomarkers and systemic factors for early and long term anatomical treatment response in diabetic macular edema}},
author = {Tuğçe Özdemir and Gürkan Erdoğan and Zafer Cebeci},
journal = {BMC Ophthalmology},
year = {2026},
month = sep,
doi = {10.1186/s12886-026-05350-2},
url = {https://doi.org/10.1186/s12886-026-05350-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic value of OCT biomarkers and systemic factors for early and long term anatomical treatment response in diabetic macular edema
AU - Tuğçe Özdemir
AU - Gürkan Erdoğan
AU - Zafer Cebeci
PY - 2026
DA - 2026/09/17
JO - BMC Ophthalmology
DO - 10.1186/s12886-026-05350-2
UR - https://doi.org/10.1186/s12886-026-05350-2
AB - Background: To evaluate the prognostic value of baseline optical coherence tomography (OCT) biomarkers and systemic factors for early and long-term anatomical response to anti-VEGF therapy in diabetic macular edema (DME). Methods: This retrospective study included 164 eyes from 105 patients with type 2 diabetes and DME who received three monthly loading doses of intravitreal bevacizumab (January 2013 to April 2024) and were subsequently managed with a pro re nata (PRN) regimen using standard retreatment criteria. Completion of the loading phase (minimum follow-up, 3 months) was required for inclusion. Anatomical response was assessed after the loading phase (early response) and at final follow-up (long-term response); eyes were classified as full, partial, or non-responders based on CMT and OCT morphology. Baseline demographic, systemic, and OCT characteristics were analyzed using generalized estimating equation (GEE) logistic regression to account for inter-eye correlation, followed by one-eye-per-patient sensitivity analyses. Results: After loading, 10 eyes (6.1%) were full responders, 72 (43.9%) partial responders, and 82 (50.0%) non-responders; 90% of early full responders maintained full response at final follow-up. In multivariable GEE analyses, higher baseline CMT, higher hyperreflective foci (HRF) count, and hyperreflective intraretinal material were independently associated with early anatomical response under the original percentage-reduction outcome definition; for long-term response, baseline CMT was only nominally associated and did not survive correction for multiple testing, and DRIL, EZ/ELM defect, and intraretinal cyst size were not significant. Both models showed moderate discrimination after bootstrap optimism correction (AUC 0.751 and 0.757, respectively). Sensitivity analyses across eye-selection strategies were consistent for baseline CMT, DRIL, EZ/ELM defect, and hyperreflective material, but intraretinal cyst size was unstable; all associations were sensitive to how anatomical response was defined. Conclusions: Baseline OCT biomarkers showed candidate associations with anatomical response, but several, including the hyperreflective-material association, were not reproduced when the outcome was redefined using continuous final CMT or an absolute CMT threshold, despite robustness within the primary model. Discrimination was moderate (optimism-corrected AUC 0.75–0.76). These findings identify candidate prognostic OCT biomarkers requiring external validation before clinical application. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12886-026-05350-2.
SN - 1471-2415
ER -