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Félix Alexander Manco Lavado, María Rosalba Ramoa Osorio, M Isabel Lopez, Lucía Manzanas Leal, Ignacio Alonso de la Fuente, Mercedes Hernando Verdugo; Variations in the size of retinal cysts as a tomographic factor predictor for retreatment with Ozurdex in patients with refractory diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3262.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic macular edema is the leading cause of vision loss in diabetic patients. Usually, vision loss and increase of central retinal thickness are the retreatment criteria for refractory diabetic macular edema (rDME). The purpose of this study is to evaluate the qualitative changes in the spectral domain optical coherence tomography (SD-OCT) as a potential predictor for retreatment with dexamethasone intravitreal implant for rDME.
This is a retrospective and observational clinical study that has been conducted at the Hospital Clinico Universitario of Valladolid, Spain. All patients were followed-up for at least 6 months. Main inclusion criteria: patients must have a diagnosis of rDME treated with a dexamethasone intravitreal implant. rDME was defined as a central retinal thickness (CRT) ≥ 250µm assessed by SD-OCT which lasted at least 90 days despite one or more macular photocoagulation and/or intravitreal anti-VEGF therapy. Primary outcome: size of the retinal cysts assessed by SD-OCT using the OCT-based classification proposed by Helmy and Atta. Secondary outcomes: best-corrected visual acuity (BCVA), CRT and the SD-OCT patterns of DME.
34 eyes of 34 patients were included. Mean DME duration was 4.72±3.55 years. The cystoid DME was the most common baseline SD-OCT pattern (71%). Of those cystoid DMEs, at baseline 79% were at stage III of Helmy and Atta’s OCT-based classification (mean baseline BCVA 0.855±0.44 LogMAR and mean baseline CRT 516±148µm), 84.6% were at stage I or II at month 1 (mean BCVA 0.758±0.51 LogMAR, p<0.05; and mean CRT 312±83µm, p<0.05 at month 1), and a high percentage of 61.5% were at stage III again at 3rd month (mean BCVA 0.760±0.58 LogMAR, p<0.05; and mean CRT 394±124µm, p<0.05 at month 3). A shift from stage I-II to stage III (increase in the size of retinal cysts) at the 3rd month of the study was evidenced, associated with minimal changes in CRT and without significant changes in visual acuity. The mean BCVA was 0.815±0.45 LogMAR, p=0.24; and mean CRT 462±141µm, p<0.05 at month 6.
The increase in the size of the retinal cysts associated with mild changes in central retinal thickness at month 3 after the beginning of treatment could be considered an indicator of recurrence of the refractory diabetic macular edema, and may predict the need for early retreatment with ozurdex.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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