Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants

Yu-Te Huang; Yen-Chieh Chang; Ping-Ping Meng; Chun-Ju Lin; Chun-Ting Lai; Ning-Yi Hsia; Huan-Sheng Chen; Peng-Tai Tien; Henry Bair; Jane-Ming Lin; Wen-Lu Chen; Yi-Yu Tsai

doi:10.3389/fmed.2022.852022

Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants

Front Med (Lausanne). 2022 Jun 9:9:852022. doi: 10.3389/fmed.2022.852022. eCollection 2022.

Authors

Yu-Te Huang¹, Yen-Chieh Chang¹, Ping-Ping Meng¹, Chun-Ju Lin^{1

2

3}, Chun-Ting Lai¹, Ning-Yi Hsia¹, Huan-Sheng Chen⁴, Peng-Tai Tien^{1

5}, Henry Bair^{1

6}, Jane-Ming Lin^{1

3}, Wen-Lu Chen^{1

3}, Yi-Yu Tsai^{1

2

3}

Affiliations

¹ Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
² School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Optometry, Asia University, Taichung, Taiwan.
⁴ An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan.
⁵ Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
⁶ Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States.

Abstract

Purpose: To identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant.

Materials and methods: Sixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment.

Results: The presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75-21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05).

Conclusion: OCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.

Keywords: diabetic macular edema (DME); disorganization of retinal inner layers; hyperreflective foci; intravitreal dexamethasone implant; optical coherence tomography biomarkers; subretinal fluid.