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We systematically map the evidence on optical coherence tomography (OCT) biomarkers-mainly disorganization of the retinal inner layers (DRIL), disruption of the retinal outer layers (DROL, including ellipsoid zone, and external limiting membrane,--and others like central retinal thickness -as predictors of visual and anatomical response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in diabetic macular edema (DME). DME remains the leading cause of vision loss in diabetic retinopathy. Despite anti-VEGF therapy being the standard treatment, patient responses vary. OCT biomarkers have emerged as promising noninvasive predictors, but inconsistencies in definitions and methodologies across studies limited their clinical use. We included studies assessing OCT biomarkers in DME patients treated with anti-VEGF agents, regardless of geography or language. Databases searched were PubMed, Embase, Scopus, and ProQuest. Screening and data extraction were conducted independently by 2 reviewers. Thirteen studies (~1150 eyes) met inclusion criteria. Baseline DRIL and DROL were consistently associated with poorer visual outcomes, while their resolution correlated with improved recovery. Reported odds ratios ranged from 2.8 to 8.7. Approximately 60 % of patients without these disruptions experienced favourable outcomes. We concluded that DRIL and DROL have strong potential as OCT biomarkers for predicting anti-VEGF response in DME. Standardized definitions and artificial intelligence-based longitudinal studies are warranted.
Sushma et al. (Fri,) studied this question.