Macular edema resolution assessment with implantable dexamethasone in diabetic retinopathy (MERIT): a pilot study

Abstract

PurposeThis study aimed to evaluate the effect of dexamethasone implantation on the hard exudates (HEX) in patients with diabetic macular edema (DME).Study designThis was a nonrandomized open-label single-center prospective trial.MethodsThis study included 15 eyes of 11 subjects with DME. Key inclusion criteria were naïve eyes with DME with HEX within 3 mm of fovea with center-involving DME; central macular thickness (CMT) >250 μm at baseline; best-corrected visual acuity (BCVA) between 20/400 and 20/40. Key exclusion criteria were previous intraocular surgery and history of panretinal photocoagulation (PRP) in past 4 months. The primary outcome measure was change in total HEX area at the macula (in mm2) measured by semiautomated algorithm. Secondary outcome measures were change in visual acuity, low-contrast visual acuity (LCVA), retinal sensitivity (RS) on macular microperimetry, and CMT.ResultsThe total HEX area reduced from 1.5 mm2 (±1.46 mm2) at baseline to 0.89 mm2 (±1.062 mm2) at the final visit (p=0.185). The CMT improved significantly (p=0.03) from 488.67 μm (±240.66 μm) to 326.93 μm (±135.84 μm) at the final visit. Mean BCVA remained stable (p=0.95) (50.93±16.65 at baseline and 50.6±18.95 at final visit). The mean LCVA and RS showed insignificant improvement (p=0.31 and p=0.28, respectively).ConclusionOur pilot study demonstrated an improving trend in reduction of total HEX area and other anatomical outcomes, with limited functional outcomes. Larger randomized studies with a larger sample size with a control group are warranted to establish management protocols for DME with significant subfoveal HEX.

Comparison of Fundus-Guided Microperimetry and Multifocal Electroretinography for Evaluating Hydroxychloroquine Maculopathy

“…Due to the fact that MP is a subjective test and may be less specific than mfERG, it may be better suited as an initial screening test rather than a confirmatory or follow-up test. Although there are a limited number of studies utilizing MP to assess retinopathy in HCQ participants, this modality is being adopted as an effective outcome measure in various retinal conditions, such as retinal dystrophies,25–27 diabetes,28,29 and age-related macular degeneration 30. The main limitations in our study are that SAPs were not available for all patients or had been done with either a white 10-2 or a red 10-2 or white 30-2 stimulus, thus precluding comparison of HVF and MP, and SD-OCT was available only on 17 (68%) of the HCQ participants.…”