Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant

Abstract

<jats:sec><jats:title>Introduction:</jats:title><jats:p> To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p &lt; 0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months. </jats:p></jats:sec>

Micro‐RNAs in the aqueous humour of patients with diabetic macular oedema

“…Finally, the subtypes of DMO could not be considered in this study due to the small number of subjects. Since the morphologic differences of DMO, such as cystoid oedema, serous detachment or diffuse retinal thickening, are now thought to be caused by different mechanisms and cause different outcomes, 50 further studies with larger sample sizes are needed to account for DMO type.…”

Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses – An Updated Review

“…32 Additionally, all 3 subtypes showed sustained functional and morphological gains with dexamethasone in the eyes, with all 3 subtypes of persistent macular edema recalcitrant to anti-VEGF. 38 The current literature on morphological patterns of DME responding to anti-VEGF therapy does not provide sufficient evidence that can be used as prognostic factor for visual outcome.…”