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Ophthalmology. 2018 Feb;125(2):267-275. doi: 10.1016/j.ophtha.2017.08.031. Epub 2017 Sep 19.

OCT Biomarkers as Functional Outcome Predictors in Diabetic Macular Edema Treated with Dexamethasone Implant.

Author information

1
Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dinahzur@gmail.com.
2
University of Buenos Aires, Argentina.
3
Department of Ophthalmology, University of Leipzig, Germany.
4
Eye Clinic - Department of Biomedical and Clinical Science "L. Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.
5
Favaloro University Hospital, Buenos Aires, Argentina.
6
Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel.
7
Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey.
8
L.V.Prasad Eye Institute, Banjara Hills, Hyderabad, 500 034 India.
9
Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
10
Service d'Ophtalmologie, Hôpital Lariboisière, AP-HP, Université Paris 7, Sorbonne Paris Cité, Paris, France.
11
Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
12
Department of Ophthalmology, Azienda Ospedaliero Universitaria Sassari, Sassari, Italy.
13
Eye Clinic - Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Italy.
14
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
15
Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
16
Department of Biomedical and Surgical Sciences, Section of Ophthalmology University of Perugia, Perugia, Italy.
17
Servicio de Retina, Centro Medico Zambrano Hellion, Tecnológico de Monterrey, San Pedro Garza García, Nuevo Leon, Mexico.
18
RetinaPro Clinic, Belem, Para, Brazil.
19
Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, Spain.

Abstract

PURPOSE:

Identification and characterization of patients with diabetic macular edema (DME) are important for individualizing treatment and optimizing outcome. We investigated OCT biomarkers for DME treated by intravitreal dexamethasone (DEX) implant.

DESIGN:

Multicenter, retrospective, observational cohort study.

PARTICIPANTS:

A total of 299 eyes from 284 patients treated with DEX implant for DME (naïve, n = 209; refractory, n = 90). Baseline best-corrected visual acuity (BCVA) was between 0.3 and 1.0 on a logarithm of minimum angle of resolution visual chart.

METHODS:

The OCT scans previous to DEX implants were evaluated for submacular fluid, size and location of cystoid changes, inner segment-outer segment (IS-OS) continuity, quantity and location of hyperreflective foci (HRF), vitreomacular interface abnormalities, and epiretinal membrane. The BCVA and central macular thickness were recorded at baseline and at 1, 2, and 4 months after treatment with DEX implants. Correlations between OCT measures and visual outcome were analyzed using the generalized estimating equations procedure.

MAIN OUTCOME MEASURES:

The correlation between spectral-domain (SD) OCT measures at baseline and BCVA response (mean change from baseline; categorized improvement [<5, 5-9, or ≥10; Early Treatment Diabetic Retinopathy Study letters] in BCVA) after treatment with a DEX implant.

RESULTS:

The presence of subretinal fluid (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.23-3.20; P = 0.01), absence of HRF (OR, 3.66; 95% CI, 1.40-9.62; P = 0.01), and integrity of the IS-OS layer (OR, 2.09; 95% CI, 1.30-3.37; P = 0.003) were all predictive of better visual outcome after treatment with DEX implants. Although eyes with naïve DME gained more vision than refractory eyes (P < 0.001), the predictive value of OCT findings did not differ according to this classification.

CONCLUSIONS:

Spectral-domain OCT is useful in identifying various imaging findings in DME. Among eyes with DME, those with submacular fluid, no HRF, and a continuous IS-OS layer responded better to DEX implants than those without these features. These findings call for further study of combinations of OCT and metabolic biomarkers.

PMID:
28935399
DOI:
10.1016/j.ophtha.2017.08.031
[Indexed for MEDLINE]

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