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Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers
Author(s) -
Bonfiglio Vincenza,
Reibaldi Michele,
Pizzo Alessandra,
Russo Andrea,
Macchi Iacopo,
Faro Giuseppe,
Avitabile Teresio,
Longo Antonio
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13935
Subject(s) - medicine , ophthalmology , ranibizumab , dexamethasone , optical coherence tomography , visual acuity , retinal , diabetic macular edema , diabetic retinopathy , diabetes mellitus , surgery , bevacizumab , endocrinology , chemotherapy
Purpose To analyse the effects of intravitreal dexamethasone implant ( DEX ) in patients with diabetic macular oedema ( DME ) unresponsive to ranibizumab treatment, in relation to the inflammatory optical coherence tomography ( OCT ) retinal features, subfoveal neuroretinal detachment ( SND ) and hyperreflective retinal spots ( HRS ). Methods Patients with DME poorly responsive to three injections of ranibizumab were treated with DEX . Best‐corrected visual acuity ( BCVA ) and central macula thickness ( CMT , measured by Spectralis SD ‐ OCT ) were assessed at baseline and at 1, 3, and 6 months. Results Overall, 44 eyes were included in the study. In the whole group, mean BCVA (baseline 51.5 ± 8.3 letters) increased significantly at 1 month (to 56.9 ± 8.8 letters; Tukey HSD p = 0.017) and was 55.5 ± 8.8 letters at 3 months (Tukey HSD p = 0.128). Central macula thickness ( CMT ) reduced significantly at 1 and 3 months (417 ± 149 μ m and 469 ± 128 μ m, respectively, both Tukey HSD p < 0.001 versus baseline). Subgroup analysis showed a significant BCVA increase at 1 month in eyes with SND + HRS (from 51.2 ± 9.2 to 58.2 ± 9.0, p = 0.029), and a trend to BCVA increase in eyes with HRS (from 52.3 ± 6.4 to 56.8 ± 7.9, p = 0.080), with a significant CMT decrease in both groups (p < 0.001). No changes of either parameter were found in eyes without SND and HRS . Conclusion Spectral domain OCT is useful in identifying some inflammatory features in DME . Among DME eyes ‘poorly responsive’ to ranibizumab, those with SND and HRS responded better to DEX implants than those without these features.