Abstract
Purpose We aimed to assess the changes of retinal microvascular parameters using optical coherence tomography angiography (OCTA) between diabetes macular edema (DME) and controls. We assessed the changes between the baseline microvascular parameters and final treatment response in patients with DME, initially treated with intravitreal dexamethasone (DEX) implant followed by antivascular endothelial growth factor (VEGF) injections on an as-needed basis. Methods This retrospective study included 90 DME patients and 24 healthy control subjects. All subjects had their best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured at baseline and after 12 months. Vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the deep/superficial flow ratio at baseline were analyzed. A subgroup analysis was used to compare the treatment response. A poor-response group was defined by five or more retreatments at 12 months. Results BCVA and CMT showed a significant improvement at 12 months (all p < 0.001). The VD in the whole and parafoveal areas of the DCP was significantly reduced in DME patients compared to that in controls (all p < 0.05). The DCP/SCP flow ratio was also significantly reduced in the DME group (1.08 ± 0.03 vs. 1.05 ± 0.02, p = 0.001). In the subgroup analysis, the VD in the foveal and whole DCP areas was significantly lower in the poor-response group than that in the good-response group (p = 0.043 and p = 0.048, respectively). The DCP/SCP flow ratio was also significantly lower in the poor-response group (p = 0.011). Conclusion DME correlated with significant retinal microvascular impairment in the DCP. A decreased DCP/SCP flow ratio was observed in patients with DME that exhibited a poor treatment response. Retinal microvascular parameters could predict the treatment response in DME and help optimize clinical outcomes.
Highlights
Diabetic macular edema (DME), macular thickening due to diabetic retinopathy (DR), can present at any stage of this disease. It is caused by a blood-retinal barrier defect that leads to vascular leakage and fluid accumulation [1]. This process is the outcome of the expression of inflammatory factors, including vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1, interleukin-6, and monocyte chemotactic protein-1, and leukostasis [2, 3]
We demonstrated that intravitreal DEX implant injection as initial therapy combined with anti-VEGF therapy on a pro re nata (PRN) basis is effective for treating DME
Several studies have evaluated the hard exudate or the microstructure with optical coherence tomography (OCT) to identify variables predicting the treatment response, we focused on the retinal microvascular changes evaluated with optical coherence tomography angiography (OCTA) at baseline
Summary
Diabetic macular edema (DME), macular thickening due to diabetic retinopathy (DR), can present at any stage of this disease. It is caused by a blood-retinal barrier defect that leads to vascular leakage and fluid accumulation [1]. Intravitreal injection of anti-VEGF agents is a standard treatment for DME approved by the United States Food and Drug Administration [5]. This treatment poses a heavy financial burden on patients because of the numerous
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