OCT biomarkers as predictors of visual improvement in diabetic macular edema eyes receiving dexamethasone implants

Giacomo Visioli; Ludovico Alisi; Elvia Mastrogiuseppe; Giuseppe Maria Albanese; Enrico Romano; Ludovico Iannetti; Marta Armentano; Francesca Giovannetti; Magda Gharbiya

doi:10.1186/s40942-023-00473-w

OCT biomarkers as predictors of visual improvement in diabetic macular edema eyes receiving dexamethasone implants

Int J Retina Vitreous. 2023 Jun 14;9(1):35. doi: 10.1186/s40942-023-00473-w.

Authors

Giacomo Visioli¹, Ludovico Alisi¹, Elvia Mastrogiuseppe¹, Giuseppe Maria Albanese², Enrico Romano¹, Ludovico Iannetti³, Marta Armentano¹, Francesca Giovannetti¹, Magda Gharbiya¹

Affiliations

¹ Department of Sense Organs, Faculty of Medicine and Odontology, Policlinico Umberto I, Sapienza University of Rome, viale del Policlinico 155, Rome, 00161, Italy.
² Department of Sense Organs, Faculty of Medicine and Odontology, Policlinico Umberto I, Sapienza University of Rome, viale del Policlinico 155, Rome, 00161, Italy. giuseppemaria.albanese@uniroma1.it.
³ Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.

Abstract

Background: Several optical coherence tomography (OCT) biomarkers have been proposed as predictors for functional and anatomical outcomes in Diabetic Macular Edema (DME). This study aims to examine the impact of these OCT features on the visual acuity improvement of patients with DME after long-acting Dexamethasone intravitreal implants (DEX-I) injection. Furthermore, the safety and impact of DEX-I on clinical parameters, including intraocular pressure (IOP) were assessed.

Methods: In this retrospective observational study, we reviewed the medical records of naïve and non-naïve eyes with DME who received at least one DEX-I. The primary endpoint was visual acuity improvement of ≥ 5 ETDRS letters at 1 month and 4 months after treatment. Secondary outcomes were the changes in OCT biomarkers and the impact of DEX-I on IOP at 1 and 4 months of follow-up. Linear panel regression analysis was used to test for differences in central subfield thickness (CST) over time and it was stratified according to biomarkers at baseline. Finally, a logistic regression analysis was used to identify factors predicting visual improvement at 1 and 4 months.

Results: We included 33 eyes of which 63.6% were at an advanced stage of DME. Overall, CST, cube average thickness (CAT), cube volume (CV), and intraretinal cystoid spaces > 200 μm (ICS) decreased following DEX-I injection (p < 0.001). Additionally, a thicker CST at baseline was observed in eyes with better visual improvement at one month (p = 0.048). After logistic regression analysis, CST was retained as the only predictor for visual improvement at one month (p = 0.044). Furthermore, panel regression analysis identified a relation between subfoveal neuroretinal detachment (SND) at baseline and CST increase at four months. Lastly, only 15.2% of the eyes necessitated topical medication for IOP reduction, with no differences observed when stratifying between naïve and non-naïve eyes.

Conclusion: Our analyses suggest that a ticker baseline CST may serve as a positive predictor of early visual improvement and SND presence at baseline may be a negative prognostic factor for CST increase 4 months after DEX-I injection. Other well-known biomarkers, such as disorganization of the inner retinal layers (DRIL) and hyperreflective foci (HF), did not demonstrate prognostic value on visual outcomes, at least within the first four months following the injection.

Keywords: Biomarkers; Central subfield thickness; Dexamethasone implant; Diabetic macular edema; Optical coherence tomography; Subfoveal neuroretinal detachment.