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Clément DUBOIS-ROUSSEL, Benedicte Marie Dupas, Ali Erginay, Pascale G Massin, Ramin Tadayoni; Increased fixation stability after intravitreal treatment for chronic diabetic macular edema as a predictor of favorable visual outcome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1777.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose : To evaluate macular function with microperimetry in case of chronic diabetic macular edema (DME) with poor vision, treated with with intravitreal injections.
Methods : This prospective study enrolled consecutive patients with chronic DME (duration > 1,7 years) and considered insufficiently responsive to standard therapies (i.e, : VA gain <5 letters after at least one prior laser treatment and use of intravitreal anti-VEGF or triamcinolone). Patients were treated with an intravitreal microimplant providing sustained-release, low-dose (0,2μg/day) of fluocinolone acetonide (Illuvien, Alimera Sciences Inc.) and followed for 6 months. Outcome measures included at baseline, 1, 3 and 6 months after intravitreal injection: fixation stability, macular sensitivity using microperimeter (MAIA, CenterVue, Padova, Italy), ETDRS best corrected visual acuity (BCVA), and central macular thickness measurement (CMT) using Spectral Domain OCT. Patients with a 20% or greater reduction in CMT at the 6-months study visit were defined as anatomic responders, and patients with final BCVA gain > 10 letters were defined as visual responders.
Results : Fifteen eyes of 14 patients were included. Mean duration of DME was 6,3 ± 3years, median HbA1c level was 7,7 ±1 %. At baseline, mean BCVA was 46,8±11 letters ETDRS and mean CMT was 646± 180 μm. Seven of 15 eyes (46%) showed improvement in fixation stability and retinal sensitivity after complete (n=4) or partial (n=3) resolution of DME. Improvement of microperimetric parameters was always associated with anatomic response, but not visual response (4 of 7 eyes (57%) had poor visual response despite fixation stability improvement). The 8 remaining eyes showed no improvement in fixation stability, retinal sensitivity, or BCVA despite anatomic response in 3 cases.
Conclusion : More than half of patients with DME and poor VA gain despite favorable anatomic response after intravitreal therapy, showed an improvement in fixation stability, and potentially better visual performances. Microperimetry may be more sensitive than BCVA to evaluate functional response after intra vitreal therapy in DME, and could be used as an additionnal outcome measure in clinical practice.
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