Baseline SD-OCT characteristics of diabetic macular oedema patterns can predict morphological features and timing of recurrence in patients treated with dexamethasone intravitreal implants

Chiara M Eandi,Daniele De Geronimo,Maria Sole Polito,Mariacristina Parravano,Gian Marco Tosi,Monica Varano,Giovanni Neri,Daniela Giannini,Yannick Le Mer

doi:10.1007/s00592-020-01504-w

Abstract

AimsTo evaluate the timing and spectral-domain optical coherence tomography (SD-OCT) features of diabetic macular oedema (DME) recurrence according to baseline OCT patterns in patients treated with dexamethasone implant (DEX-I).MethodsThis is a retrospective observational study (72 eyes/65 patients). Best-corrected visual acuity, timing of DME recurrence, and SD-OCT pattern [intraretinal cysts (IRC), IRC plus subretinal fluid (mixed), external limiting membrane (ELM), ellipsoid (IS/OS) layer integrity] were assessed at baseline and monthly until first DME recurrence.ResultsForty-two (58.3%) and 30 (41.6%) DME eyes had an IRC and mixed DME pattern at baseline, respectively. Twenty-four out of thirty mixed eyes (80%) relapsed without subretinal fluid. At baseline, mixed eyes showed similar changes in ELM and IS/OS (60 and 76.6% of eyes, respectively) versus IRC eyes (42.8 and 80.9% of eyes). After DME recurrence, more mixed eyes at baseline showed ELM and IS/OS changes (63.3 and 86.6%) than IRC eyes (50 and 76.2%). 33.3% of mixed eyes had DME recurrence at ≥ 6 months from first DEX-I implant versus 19% of IRC eyes.ConclusionsMixed DME eyes were treated with DEX-I relapse later and more frequently without subretinal fluid than IRC eyes. SD-OCT characteristics of different DME patterns at baseline can predict morphological features and timing of DME recurrence.

Highlights

Diabetic macular oedema (DME), a macular thickening secondary to diabetic retinopathy (DR), results from a blood–retinal barrier defect that leads to vascular leakage and fluid accumulation [1]
To shed further light on this aspect, we evaluated the spectral-domain (SD)-optical coherence tomography (OCT) morphological features of DME recurrence according to baseline OCT patterns in patients treated with dexamethasone implant (DEX-I)
Forty-two (58.3%) and 30 (41.6%) eyes presented with an intraretinal cysts (IRC) and mixed DME pattern at baseline, respectively

Summary

Introduction

Diabetic macular oedema (DME), a macular thickening secondary to diabetic retinopathy (DR), results from a blood–retinal barrier defect that leads to vascular leakage and fluid accumulation [1]. While intravitreal anti-VEGF agents have been shown to be effective in improving best-corrected visual acuity (BCVA) and decreasing central retinal thickness (CRT), it has been suggested that they should be used with caution due to possible systemic adverse events [2]. They are not appropriate for all patients, and not all patients respond to anti-VEGF treatment; compliance to therapy remains suboptimal due to the numerous injections required [8, 9]

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Conclusion