Abstract
Purpose :
Fluctuations in macular thickness over time have been shown to be more predictive of visual outcomes than absolute macular thickness in patients with diabetic macular edema (DME) treated with anti- vascular endothelial growth factor (VEGF). However, it is unclear whether this association exists in DME patients treated with intravitreal steroids. We performed a retrospective, non-comparative, observational cohort study to investigate the effect of steroid treatment on macular thickness fluctuations (MTF) and visual outcomes in patients with DME.
Methods :
Central subfield thickness (CST) and best visual acuity (BVA) were collected in 4-month intervals over two years for DME patients over the age of 18 without concomitant maculopathies who had at least one intravitreal steroid injection. Paired t-test was used to compare MTF (quantified by CST standard deviation (CST-SD)) before and after initiation of steroid treatment. A mixed-effects linear regression model was used to determine the association between CST-SD and BVA, adjusting for baseline characteristics and treatment patterns.
Results :
Of the 108 patients included, 105 (97.2%) received anti-VEGF treatment prior to steroid initiation. Mean 12-month CST-SD after steroid initiation was significantly lower than mean 12-month CST-SD prior (53.469 ± 49.9 vs. 61.139 ± 56.77; p = 0.04). Mean BVA after 12 months was not significantly different from baseline (62.717 ± 15.2 vs. 62.997 ± 13.7; p = 0.4). There was no significant association between post-steroid CST-SD and 12-month BVA nor any significant differences in post-steroid CST-SD among the different treatment pattern groups.
Conclusions :
MTF decreased after initiation of steroid treatment with maintenance of stable visual acuity. There was no significant correlation between decreases in MTF and visual outcomes which is expected in this prior treated DME patient population receiving intravitreally steroid treatment. This reflects the routine clinical practice of using steroids as second-line treatment after anti-VEGF injections. This study demonstrates the efficacy of intravitreal steroids in reducing MTF and maintaining stable visual acuity, confirming its role in the treatment of DME.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.