Purchase this article with an account.
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.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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).
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
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.
This PDF is available to Subscribers Only