Prognostic biomarkers of chronic diabetic macular edema treated with a fiuocinolone acetonide intravitreal implant

Beatriz Oliveira Lopes; Margarida Sena Brizido; Florence Aerts; Susana Morais Pina; Pedro Santana Simoes; Margarida Isidoro Miranda

doi:10.51329/mehdioph-thal1421

Prognostic biomarkers of chronic diabetic macular edema treated with a fiuocinolone acetonide intravitreal implant

Med Hypothesis Discov Innov Ophthalmol. 2021 Aug 5;10(2):50-58. doi: 10.51329/mehdioph-thal1421. eCollection 2021 Summer.

Authors

Beatriz Oliveira Lopes¹, Margarida Sena Brizido¹, Florence Aerts¹, Susana Morais Pina¹, Pedro Santana Simoes¹, Margarida Isidoro Miranda¹

Affiliation

¹ Department of Ophthalmology, Beatriz Angelo Hospital, Loures, Portugal.

Abstract

Background: This study aimed to investigate retinal imaging biomarkers, such as disorganization of the retinal inner layers (DRIL) and/or ellipsoid zone (EZ) disruption by spectral domain optical coherence tomography (SD-OCT), and functional outcomes in eyes treated with 0.2 µg/day of a fluocinolone acetonide intravitreal implant (FAc) after an insufficient response to previous treatments.

Methods: This was a retrospective comparative study of 18 eyes (15 patients) with persistent and/or recurrent diabetic macular edema (DME) treated with FAc. Eyes were divided according to the number of prior intravitreal treatments: group 1 (n = 8) with ≤ 6 injections (early switch) and group 2 (n = 10) with > 6 injections (late switch). Outcomes included percentage of eyes with DRIL and/or EZ disruption at baseline and analysis of the best corrected visual acuity (BCVA) using ETDRS letters, central macular thickness (CMT), DRIL, and EZ disruption at the last observation.

Results: Group 2 revealed a significantly higher percentage of DRIL and/or EZ disruption than group 1 (P < 0.05). At the last observation, group 1 revealed a higher percentage of eyes achieving vision stability/ improvement, gaining ≥ 15 letters, and achieving ≥70 letters (P > 0.05 for all comparisons). The mean BCVA gain was 8.8 and 0.7 letters for groups 1 and 2 (P = 0.397). Both groups revealed a significant mean CMT reduction (> 20% reduction from the baseline value), without a significant statistical difference between them (P = 0.749). After treatment, most eyes from both groups showed resolution of DRIL and EZ disruption.

Conclusions: Patients with DME presenting with a lower percentage of DRIL and/or EZ disruption at baseline had better functional outcomes, supporting the possible benefit of an early switch to FAc after insufficient response to previous treatments. Future randomized studies with a larger patient cohort are warranted to confirm our conclusions.

Keywords: SD-OCT; central macular thickness; diabetic macular edema; disorganization of retinal inner layers; ellipsoid zone; fluocinolone acetonide intravitreal implant; prognostic biomarkers; retina imaging biomarkers; spectral domain optical coherence tomography.