Prognostic role of optical coherence tomography after switch to dexamethasone in diabetic macular edema

Role of hyper-reflective spots in predicting outcomes of intravitreal therapy in diabetic macular edema: A systematic review and meta-analysis

“…Nineteen studies were identified (thirteen were retrospective cohort studies, 12,[15][16][17]24,26,[30][31][32][33][34][35][36] three were prospective cohort studies, 37,38,41 two were case series 14,39 and one was a case-control study 40 ). The quality score of the studies is shown in Table 1.…”

“…and Conbercept], 16,24,[30][31][32]35,36,40 11 studies to dexamethasone implant 12,14,26,[32][33][34][36][37][38][39]41 and 2 studies to the sequential use of anti-VEGF and dexamethasone. 15,17 The model of spectral domain OCT used, varied among the studies: 14 used SpectralisOCT™ (Heidelberg Engineering, Heidelberg, Germany), 12,[14][15][16][17]24,26,[30][31][32]34,35,38,39 3 used Cirrus HD-OCT™ (Carl Zeiss Meditec, Dublin, CA, USA), 33,37,41 1 each Retina scan™ (RS-3000 advance; Nidek) 40 and DRI-SSOCT Triton plus™ (Topcon Medical Systems Europe, Milano, Italy). 36 The measurement of HRS was done over different area sizes in the macula (12 studies used 3000µm area, 12,[14][15][16][17]26,…”

“…A number of biomarkers are being evaluated on optical coherence tomography (OCT) scans to predict responses like neurosensory detachment (NSD), 10,11 hyperreflective spots (HRS), 12 ellipsoid zone (EZ) line integrity, cystoid macular edema (CME) 10 and disorganization of retinal inner layers (DRIL). 13 HRS are small, dot-like lesions that are of equal or higher reflectivity than the retinal pigment epithelium (RPE) / nerve fiber layer with absent back shadowing on OCT. [14][15][16][17] Several theories have been postulated to explain the pathogenesis of these spots but their exact nature is still unclear. These spots are thought to be extravasated lipoproteins (precursors of hard exudates), 18 inflammatory cells (leucocytes, activated microglia), 19,20 migrated RPE cells 21 or photoreceptor fragments.…”

“…22 Significant research is underway to understand the predictive value of this biomarker in determining the final VA, reduction in central macular thickness (CMT), recurrence patterns and duration of action of intravitreal implants. 14,15,[22][23][24][25][26] The majority of the current literature on HRS in DME consists of small retrospective/prospective cohort studies. Though some studies have shown conflicting results, it seems promising that HRS could be used as a reliable marker of disease burden and response to therapy in DME.…”

Management of patients with diabetic macular oedema and good visual acuity: new findings from Protocol V

“…Nonetheless, the anti-VEGF treatment was also displayed to produce an amelioration in DR severity [9], even without an enhancement in retinal perfusion [10]. Of note, in a number of cases the anti-VEGF treatment may be ineffective and in these cases a switch to other treatments, including intravitreal dexamethasone, was proved to be potentially effective, especially in presence of definite imaging biomarkers [11].…”