Abstract
Purpose :
To evaluate the presence of specific swept-source optical coherence tomography (SS-OCT) retinal biomarkers for inflammation or vasculogenic disorder in patients with diabetic macular edema (DME) to identify a target therapy for each patients.
A retrospective analysis on the SS-OCT data in a cohort of patients (treatment naïve) without any concomitant macular diseases.
Methods :
This study involved 65 eyes of 46 patients divided in three treatment groups. In anti-VEGF group 20 eyes received 3 monthly intravitreal injections of Ranibizumab, in Dexamethasone group 20 eyes received intravitreal implant of dexamethasone, in laser group 25 eyes treated with multispot (focal/grid) laser photocoagulation (Pascal, Topcon®).
All patients underwent full ophthalmologic examination at baseline (V1) and after six months from the treatment (V2), with best-corrected visual acuity (BCVA, ETDRS charts), fundus photograph, SS-OCT (Triton-plus Topcon) radial 9x9 mm focused on the macular area.
The biomarkers evaluated were: number of hyper reflective retinal spots (HRS), central retinal thickness (CRT), serous detachment of neuroepithelium (SDN),vitreo-macular adhesion, epiretinal membrane, turn-over of red-dots, intraretinal cysts (IRC) and Choroidal thickness. The changes between V1 and V2 were assessed by Wilcoxon test, the differences between the three groups of treatment were calculated by Mann Whitney test, considering a p<0.005 statistically significant.
Results :
At V2 in all groups BCVA improved (p<0.005), otherwise a significantly decrease in CRT p=0.001, IRC p=0.001, SDN p=0.013, HRS p=0.023, Red Dots p=0.021 was observed. There was no significant changes in the Choroidal thickness.
In anti-VEGF group BCVA improved p= 0.007 and decreased CRT p=0.009, IRC p=0.003, HRS p=0.09 Red Dots p=0.025 and there was no statistically significant changes of Choroidal thickness and SDN at V2. In dexamethasone group BVA improved p=0.040 and decreased CRT p=0.004, IRC p= 0.011, SDN p=0.046 and Choroidal thickness p=0.047 at V2. In laser group laser only CRT decreased p=0.033 and there was no statistically significant changes of Choroidal thickness and SDN at V2.
Conclusions :
Biomarkers of chronic inflammation (SDN and choroidal thickness) were improved only in the group of patients treated with intravitreal implant of dexamethasone.Therefore, the occurrence of such OCT retinal biomarkers may be used to influence clinical decisions for treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.