Abstract
Purpose To investigate the associations between hyperreflective foci (HRF) on spectral-domain optical coherence tomography (SD-OCT) and early recurrence of macular edema after intravitreal dexamethasone (DEX) implantation in eyes with refractory diabetic macular edema (DME) to bevacizumab. Methods Medical records of patients with refractory DME to bevacizumab, who underwent intravitreal DEX implantation and 12-month follow-up, were reviewed. Eyes in which central subfield thickness (CST) increased over 50 μm at 3 months compared with the first month after intravitreal DEX implantation were categorized into the early recurrence group, and the others were categorized into the late recurrence group. Best-corrected visual acuity (BCVA), CST, and number of HRF on SD-OCT were analyzed. Results Twenty-nine eyes of 26 patients (16 eyes in the early recurrence group and 13 eyes in the late recurrence group) were included in this study. The numbers of HRF in entire retina, inner retina, and outer retina at baseline in the early recurrence group (11.38 ± 3.07 in entire retina, 5.44 ± 1.50 in inner retina, 5.94 ± 2.74 in outer retina) were significantly greater than those in the late recurrence group (7.54 ± 3.60 in entire retina, p=0.006; 4.08 ± 1.70 in inner retina, p=0.034; 3.46 ± 2.30 in outer retina, p=0.013). Multivariate logistic regression analysis showed that a higher number of HRF increased the risk of early recurrence after intravitreal DEX implantation (odds ratio in entire retina: 1.518, p=0.012; odds ratio in inner retina: 2.058, p=0.027; odds ratio in outer retina: 1.610, p=0.029). Conclusions Higher baseline numbers of HRF on SD-OCT may be a predictive indicator of early recurrence of macular edema after intravitreal DEX implantation for DME.
Highlights
Diabetic macular edema (DME), which affects approximately 6.8% of the diabetic population, is the most common cause of visual impairment in patients with diabetic retinopathy [1, 2]
If there was a way to know in advance the early recurrence of DME after intravitreal DEX implantation, retreatment could be initiated in high-risk patients in a timely manner, which probably improves prognosis. erefore, in our study, we aimed to investigate the association between the number of hyperreflective foci (HRF) on spectral-domain optical coherence tomography (SD-OCT) and early recurrence of DME after intravitreal DEX implantation
Refractory DME was defined as worsening of Best-corrected visual acuity (BCVA) by 2 Early Treatment Diabetic Retinopathy Study (ETDRS) lines or reduction of less than 10% of retinal thickness on SD-OCT measured 1 month after more than at least three times anti-vascular endothelial growth factor (VEGF) injections that were given at monthly intervals [7]
Summary
Diabetic macular edema (DME), which affects approximately 6.8% of the diabetic population, is the most common cause of visual impairment in patients with diabetic retinopathy [1, 2]. Since vascular endothelial growth factor (VEGF) is an essential endogenous mediator of DME, antiVEGF injections are effective in improving visual acuity and are generally considered as first-line therapy for DME [3]. In patients with poor initial response to anti-VEGF agents, intravitreal steroid injection may be an alternative choice of treatment because inflammation plays an important role in the pathogenesis of DME [8, 9]. Dexamethasone (DEX) intravitreal implant 0.7 mg (Ozurdex; Allergan, Inc., Irvine, CA, USA) is a widely used agent for DME because it leads to improvement in visual acuity and decrease in retinal thickness [10, 11], even in eyes with DME that do not respond adequately to antiVEGF treatment [12,13,14].
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