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Stela Vujosevic, Caterina Toma, Marco Brambilla, Andrea Muraca, Emanuele Torti, Giordana Florimbi, Stefano De Cillà; Diabetic macular edema with subfoveal neuroretinal detachment: OCT and OCT-angiography changes after intravitreal steroids and anti-VEGF treatment. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2607.
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To assess and compare early changes in neuro-inflammatory and vascular parameters in diabetic macular edema(DME) with subfoveal neuroretinal detachment(SND) after treatment with Dexamethasone(DEX) and Ranibizumab(IVR).
107 eyes with DME treated with intravitreal injections(IV) at the University Hospital of Novara were retrospectively evaluated; a subgroup of 25 eyes with SND, 13 treated with DEX and 12 with 3 IVR, were included. Inclusion criteria were: full eye examination, good quality OCT and OCT-A images(DRI Triton plus, Topcon Medical System Europe, Milano, Italy) before and 2 months after DEX and 1 month after 3IVR. Major exclusion criteria were: any ocular pathology other than DME; any previous ocular treatment. Quantitative OCT parameters were:central macular thickness(CMT); number of hyper-reflective retinal spots(HRS) in inner and outer retina(IR,OR) and in full macula(IR+OR), central choroidal thickness(CT). Qualitative parameters included: presence of disorganization of inner retinal layers;outer retina integrity. On OCT-A:foveal avascular zone(FAZ) area and circularity index in the superficial capillary plexus; perfusion density and vessel density in both retinal plexuses and in choriocapillaris(CC). FAZ was analyzed using ImageJ(version 1.51, NIH, USA), perfusion parameters using MatLab, after removal of artifacts.Two-sample Student’s t-test was used for quantitative data and Mann-Withney U-test for qualitative data.
CMT decreased significantly after both DEX(p<0.001) and IVR(p=0.016), (-38% after DEX vs -20% after IVR,p=0.06). A significant decrease in HRS in the IR (p<0.001) and IR+OR(p=0.002) was found only after DEX(-27% after DEXvs-3% after IVR in the IR, p=0.03).CT decreased significantly after both treatments,(p<0.05), (-11% after DEXvs-16% after IVR, p=0.37). All qualitative parameters improved in both groups, without differences between DEX and IVR. No significant changes in FAZ parameters were found. Perfusion parameters in the retina increased after both treatments, in the CC only after DEX.
Both steroids and anti-VEGF improved macular morphology and retinal vascular perfusion. HRS decreased and CC perfusion increased only after DEX. Significant and more pronounced changes, after steroid vs anti-VEGF treatment, in specific inflammatory and vascular parameters are documented by OCT and OCT-A.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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