Macular and peripapillary microvasculature after dexamethasone injection in diabetic macular edema

Abstract

Purpose To evaluate the microvascular changes in the macular and peripapillary area after intravitreal dexamethasone implant in diabetic macular edema (DME) Material and Methods We included 31 eyes of 31 patients treated with a single dose dexamethasone implant for DME. All subjects underwent swept-source optical coherence tomography (OCT) and OCT angiography imaging before (T0), and one month (T1), two months (T2), and four months (T4) after dexamethasone injection. The foveal avascular zone (FAZ) area of superficial and deep capillary plexus (SCP and DCP) was calculated by delineating the FAZ border using the measurement tool of the device. The vessel density (VD) of SCP and DCP and choriocapillaris (CC) in the macular and peripapillary area were automatically calculated. Results There was an insignificant reduction in FAZ area measurements of SCP after dexamethasone injection in DME patients (p = 0.846). The FAZ area of DCP were significantly smaller compared to T0 measurements at T1, T2, and T4 (p = 0.013, p = 0.031, and p = 0.029, respectively). The mean average parafoveal VD measurements were significantly decreased after dexamethasone injection in SCP and DCP (p = 0.004, p = 0.005). The peripapillary VD in retinal capillary plexuses and choriocapillaris showed no significant difference after dexamethasone injection. Conclusion Intravitreal dexamethasone leads to a significant FAZ area decrease in DCP with a reduction in parafoveal VD measurements. In addition, no significant VD changes were observed in the peripapillary area after dexamethasone. These findings indicate that dexamethasone may improve macular ischemia with no significant effects on peripapillary microvasculature in DME patients.

Retinal Microvascular Changes after Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema

“…Similar to some previous studies, we found in the present study that there was no significant change in the vessel density of the SCP and DCP, with the exception of two quadrants of the superior and inferior SCP. In contrast, the present study did show that there was significant enlargement of the FAZ area after the administration of TA (before: 0.29 ± 0.10 mm 2 , after: 0.32 ± 0.13 mm 2 p < 0.041), which is not consistent with the previous report on the intravitreal dexamethasone implant [23][24][25]. To the best of our knowledge, at the present time, there have been no data reported on OCTA parameters that include information on microaneurysms after the intravitreal injection of TA.…”

“…The findings were not confounded in the patients on steroids. However, there are other studies that found that there were no significant changes in the vessel density (SCP and DCP) [22][23][24] and that there was a decrease in the FAZ area after an intravitreal dexamethasone implant [23,24]. In contrast, Carnota-Méndez et al reported finding that there was a reduction in the vessel density and vascular perfusion in the absence of any changes in the FAZ area after the administration of dexamethasone [25].…”

Short-term peripapillary structural and vascular changes following anti-VEGF vs. Dexamethasone intravitreal therapy in patients with DME

“…Our results showed that DEX-I seems to have no side effects on RNFL thickness, IOP and peripapillary VD in a 1-month period. Similarly, Ozcalıskan et al 31 found macular reperfusion after DEX-I with no significant impact on peripapillary capillaries in DME patients. The long-term DEX-I effects on the RNFL are not well known.…”