Abstract
The aim of this study was to investigate retinal and choriocapillaris vessel changes in diabetic macular edema (DME) after the intravitreal dexamethasone implant (IDI) using optical coherence tomography angiography (OCTA). Moreover, a comparison between morphological and functional parameters of DME and healthy patients was performed. Twenty-five eyes of 25 type 2 diabetic retinopathy patients complicated by macular edema (DME group) and 25 healthy subjects (control group) were enrolled. Superficial capillary plexus density (SCPD) and deep capillary plexus density (DCPD) in the foveal and parafoveal areas, choricapillary density (CCD) and optic disc vessel density (ODVD) were detected using OCTA at baseline and after 7, 30, 60, 90 and 120 days post injection. Best corrected visual acuity (BCVA), retinal sensitivity, and central retinal thickness (CMT) were also evaluated in both groups of patients. A statistically significant difference between the two groups (DME and controls) was found in terms of functional (MP, p < 0.001 and BCVA, p < 0.001) and morphological (CMT, p < 0.001; SCPD in the parafoveal area, p < 0.001; DCPD in the foveal area, p < 0.05 and parafoveal area, p < 0.001; CCD, p < 0.001) parameters. After the treatment, SCPD and DCPD in the foveal and parafoveal areas did not modify significantly during the follow up.
Highlights
IntroductionDiabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in the working age population [1].Regardless of the widespread use of new therapies, including the anti-vascular endothelial growth factor (VEGF) agents and corticosteroids, diabetic macular edema (DME) remains a common DR complication, and it is estimated to affect about 20% of the diabetic retinopathy patients in the United States [2].The DME etiology is still being investigated, and it is probably related to an inflammatory condition [3].Capillary leakage and fluid accumulation, due to a breakdown of the blood-retinal barrier, involve the expression of inflammatory factors, such as intercellular adhesion molecule-1, interleukin-6, monocyte chemotactic protein-1, leukostasis and VEGF [3].In the armamentarium of intravitreal agents, the anti VEGFs were the first drugs approved for diabetic macular edema treatment [4].the intravitreal dexamethasone implant (IDI) is considered an effective corticosteroid in the treatment of DME
No treatment-related complications were observed during the follow up, including intraocular pressure increase requiring hypotonic eye drops and progression of lens opacity evaluated by means of Lens Opacities Classification Systems (LOCS III) [10,11]
In this study, using optical coherence tomography angiography (OCTA), we investigated retinal superficial and deep vessel densities and choriocapillaris density in patients with diabetic retinopathy complicated by macular edema at baseline and after an intravitreal dexamethasone implant
Summary
Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in the working age population [1].Regardless of the widespread use of new therapies, including the anti-vascular endothelial growth factor (VEGF) agents and corticosteroids, diabetic macular edema (DME) remains a common DR complication, and it is estimated to affect about 20% of the diabetic retinopathy patients in the United States [2].The DME etiology is still being investigated, and it is probably related to an inflammatory condition [3].Capillary leakage and fluid accumulation, due to a breakdown of the blood-retinal barrier, involve the expression of inflammatory factors, such as intercellular adhesion molecule-1, interleukin-6, monocyte chemotactic protein-1, leukostasis and VEGF [3].In the armamentarium of intravitreal agents, the anti VEGFs were the first drugs approved for diabetic macular edema treatment [4].the intravitreal dexamethasone implant (IDI) is considered an effective corticosteroid in the treatment of DME. Regardless of the widespread use of new therapies, including the anti-vascular endothelial growth factor (VEGF) agents and corticosteroids, diabetic macular edema (DME) remains a common DR complication, and it is estimated to affect about 20% of the diabetic retinopathy patients in the United States [2]. Capillary leakage and fluid accumulation, due to a breakdown of the blood-retinal barrier, involve the expression of inflammatory factors, such as intercellular adhesion molecule-1, interleukin-6, monocyte chemotactic protein-1, leukostasis and VEGF [3]. In the armamentarium of intravitreal agents, the anti VEGFs were the first drugs approved for diabetic macular edema treatment [4]. The intravitreal dexamethasone implant (IDI) is considered an effective corticosteroid in the treatment of DME. It has been demonstrated that IDI is six times more effective than intravitreal triamcinolone acetonide [5,6]
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