Abstract
Purpose To access the choroidal structural changes of posterior subtenon triamcinolone acetonide (PSTA) injection in eyes with refractory diabetic macular edema (DME). Methods Patients with refractory DME were enrolled and followed for 4 weeks after switching to PSTA injection. All patients underwent spectral-domain optical coherence tomography with enhanced depth imaging, and the choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were evaluated before and after switching treatments. Results After switching to PSTA treatment, the final best-corrected visual acuity and central subfield thickness in eyes with refractory DME were significantly improved compared to the baseline values (P=0.002 and P < 0.001, respectively). Both the SFCT and CVI decreased during the follow-up period, and significant decreases were observed at 4-week follow-up (P < 0.001 and P=0.012, respectively). The linear regression analysis showed a significant correlation between the baseline SFCT and the final visual outcomes (P=0.047). Conclusions The alterations of SFCT and CVI in this study suggest that the choroidal vasculature is involved in the pathogenesis of refractory DME and could be affected by PSTA treatment. SFCT rather than CVI may be a prognostic biomarker for eyes with refractory DME.
Highlights
Diabetic macular edema (DME) is the leading cause of vision loss in patients with diabetic retinopathy (DR) [1]
A retrospective review was performed on patients with refractory DME who were referred to the Department of Ophthalmology at the Second Hospital of Shandong University in Jinan between January 2019 and February 2021. e study was performed in accordance with the provisions of the Declaration of Helsinki and was approved by the Ethical Review Committee of the Second Hospital of Shandong University
We found that posterior subtenon triamcinolone acetonide (PSTA) injection could significantly reduce the central subfield thickness (CST) and improve best-corrected visual acuity (BCVA) in DME eyes refractory to anti-vascular endothelial growth factor (VEGF) therapy
Summary
Diabetic macular edema (DME) is the leading cause of vision loss in patients with diabetic retinopathy (DR) [1]. Treatments for DME include anti-vascular endothelial growth factor (VEGF) agents, laser photocoagulation, steroids, and vitrectomy. Due to its significant outcomes, intravitreal injection of anti-VEGF agents has been generally accepted as the first-line therapy for DME worldwide [2,3,4]. Not all patients with DME respond to anti-VEGF treatment. E pathogenesis of DME is multifactorial and complex. More than 40% of DME patients still have thickened central macular thickness even after numerous intravitreal injections [5]. Both VEGF and other inflammatory mediators are involved in it [6]. If the response to anti-VEGF therapy is inadequate, switching to alternative treatment modalities such as steroids should be considered [2, 4]
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