July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Optical coherence tomography Biomarkers for Treatment Response to dexamethasone implant in Patients with Diabetic Macular Edema
Author Affiliations & Notes
  • Dinah Zur
    Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • Matias Iglicki
    University of Buenos Aires, Buenos Aires, Argentina
  • Catharina Busch
    Department of Ophthalmology, University of Leipzig, Leipzig, Germany
  • Alessandro Invernizzi
    Eye Clinic - Department of Biomedical and Clinical Science "L. Sacco",, Luigi Sacco Hospital, University of Milan, Milan, Italy
  • Miriana Mariussi
    Favaloro University Hospital, Buenos Aires, Argentina
  • Anat Loewenstein
    Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • Footnotes
    Commercial Relationships   Dinah Zur, None; Matias Iglicki, None; Catharina Busch, None; Alessandro Invernizzi, None; Miriana Mariussi, None; Anat Loewenstein, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3443. doi:
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      Dinah Zur, Matias Iglicki, Catharina Busch, Alessandro Invernizzi, Miriana Mariussi, Anat Loewenstein; Optical coherence tomography Biomarkers for Treatment Response to dexamethasone implant in Patients with Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3443.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Structural changes on optical coherence tomography (OCT) may allow to predict treatment response and optimize treatment. We investigated OCT biomarkers for treatment response to intravitreal dexamethasone (DEX) implant in patients with naïve and refractory DME.

Methods : Multicenter, retrospective, observational cohort study. Participants: Patients treated with DEX implant for naïve and refractory DME. Spectral domain (SD)-OCT scans previous to DEX implants were evaluated for subretinal fluid (SRF), cyst size and location, inner segment-outer segment (IS-OS) continuity, quantity and location of hyperreflective foci (HRF), vitreomacular interface abnormalities and epiretinal membrane. Baseline best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at baseline and at 1, 2 and 4 months after treatment with DEX implants. Outcome measures: Correlation between SD-OCT measures at baseline and BCVA response (mean change from baseline; (ETDRS) letters]) and CMT change.

Results : 299 eyes from 284 patients were included, 209 (66.9%) naïve and 90 (30.1%) refractory. The presence of subretinal fluid (OR: 1.98, 95% 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. HRF scattered in all retinal layers were predictive for non-response to treatment (OR: 0.54, 95% CI: 0.35-0.82, p=0.004).

Conclusions : SD-OCT provides useful structural biomarkers for predicting treatment response to DEX implant in DME. Eyes with submacular fluid, absence of HRF and continuous IS-OS layer responded better to DEX implants, while eyes with HRF in all retinal layers were more likely to be non-responders. Imaging parameters may be considered in treatment decisions.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

OCT Measures in DME: 1A. Serous macular detachment. 1B. Grading of intraretinal cysts size and location. 1C. DME associated with focal vitreomacular traction. 1D-F. Grading of HRF location and quantitiy. 1G-I. Grading of the inner segment-outer segment (IS-OS) integrity

OCT Measures in DME: 1A. Serous macular detachment. 1B. Grading of intraretinal cysts size and location. 1C. DME associated with focal vitreomacular traction. 1D-F. Grading of HRF location and quantitiy. 1G-I. Grading of the inner segment-outer segment (IS-OS) integrity

 

Forest plot showing baseline predictors of a ≥ 10 letters gain in BCVA at 2 (square) and 4 (triangle) months. Subretinal fluid was a positive predictor at 4 months.Disrupted IS/OS and scattered HRF were negative predictive at 2 and 2 and 4 months, respectively.

Forest plot showing baseline predictors of a ≥ 10 letters gain in BCVA at 2 (square) and 4 (triangle) months. Subretinal fluid was a positive predictor at 4 months.Disrupted IS/OS and scattered HRF were negative predictive at 2 and 2 and 4 months, respectively.

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