Abstract / Summary
Abstract Background/Objectives: To evaluate the effect of baseline ESASO OCT-based cyst stage on 24-month outcomes in treatment-naïve diabetic cystoid macular oedema (CME) receiving anti-VEGF therapy. Subjects/Methods: Multicentre retrospective cohort of 311 treatment-naïve eyes classified at baseline as ESASO Stage 1 (mild, n=94), 2 (moderate, n=99), or 3 (advanced, n=118). BCVA (logMAR) and central macular thickness (CMT) at baseline and 3, 6, 12, 18 and 24 months were analysed using linear mixed-effects models with a random intercept per eye. A sensitivity analysis adjusted for anti-VEGF agent and cumulative dexamethasone exposure.
Results: Stage 3 had worse baseline BCVA (0.744 vs. 0.537 and 0.570 logMAR; p<0.0001) and CMT (516 vs. 335 and 410 μm; p<0.0001). All groups improved significantly. At 12 months, Stage 3 had the highest proportion of ≥3-line gainers (42.4% vs. 21.3% and 25.3%; p=0.012). Between 18 and 24 months, Stage 3 showed a within-stage BCVA deterioration (+0.061 logMAR; 95% CI +0.005 to +0.116; p=0.032), while Stages 1 and 2 remained stable (p=0.41, 0.96). This decline persisted after adjusting for treatment exposure (+0.060 logMAR; p=0.034). Stage 3 required more dexamethasone implants (linear trend p=0.009) and more clinic visits by 24 months (11.7 vs. 9.9; p=0.002).
Conclusions: In advanced diabetic CME, anti-VEGF therapy produces substantial mid-term visual gains but is associated with a small, significant late-phase BCVA decline between 18 and 24 months not attributable to treatment heterogeneity. Baseline ESASO cyst staging may serve as a supportive prognostic marker alongside BCVA, identifying eyes warranting closer monitoring; prospective validation is required.