Original StudyFOVEAL MÜLLER CELL CONE AS A PROGNOSTIC OPTICAL COHERENCE TOMOGRAPHY BIOMARKER FOR INITIAL RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN CYSTOID DIABETIC MACULAR EDEMAChoi, Mihyun MD, PhD*; Yun, Cheolmin MD, PhD*; Oh, Jong-Hyun MD, PhD†; Kim, Seong-Woo MD, PhD* Author Information *Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea; and †Department of Ophthalmology, Dongguk University, Ilsan Hospital, Gyeonggi-do, Republic of Korea. Reprint requests: Seong-Woo Kim, MD, PhD, Department of Ophthalmology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea; e-mail: [email protected] Supported in part by the Bio and Medical Technology Development Program of the NRF funded in part by the Korean government and the Ministry of Science and ICT (MSIP) (NRF-2017M3A9E2056458 and 2020R1A2C1005729). None of the authors has any conflicting interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com). Retina: January 2022 - Volume 42 - Issue 1 - p 129-137 doi: 10.1097/IAE.0000000000003271 Buy SDC Metrics AbstractIn Brief Purpose: To investigate the effect of the foveal Müller cell cone structure on the anatomical and functional response to intravitreal bevacizumab treatment in patients with diabetic macular edema. Methods: In 93 treatment-naive eyes with center-involved cystic type diabetic macular edema, spectral-domain optical coherence tomography scans of baseline were retrospectively evaluated to determine the foveal Müller cell cone structure and prognostic features including length of disorganization in the retinal inner layers and ellipsoid zone disruption. The area and circularity of the foveal avascular zone of the superficial and deep capillary plexus 1 month after intravitreal bevacizumab treatment were evaluated using optical coherence tomography angiography. Results: Destruction of the foveal Müller cell cone structure and a large foveal avascular zone in the deep capillary plexus (mm2) correlated strongly with a poor anatomical response (CST > 250 µm) at 1 month after first intravitreal bevacizumab (Exp [B] = 29.444, P = 0.002 and Exp [B] = 12.419, P = 0.013, respectively). A destroyed Müller cell cone structure (P = 0.008) and length of ellipsoid zone disruption (P < 0.001) at baseline were associated with poor visual acuity at 1 month after the first intravitreal bevacizumab. Conclusion: The foveal Müller cell cone structure correlates with the response to initial antivascular endothelial growth factor treatment. This study analyzed the role of the foveal Müller cell cone in the response of cystoid diabetic macular edema to intravitreal bevacizumab (IVB) treatment. The authors noted that a destroyed foveal Müller cell cone structure in cystoid diabetic macular edema was associated with a poor response to initial intravitreal bevacizumab and poor visual acuity.