Diabetic macular edema with neuroretinal detachment: OCT and OCT-angiography biomarkers of treatment response to anti-VEGF and steroids

Abstract

Purpose

To assess and compare early changes in neuroinflammatory and vascular parameters in diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND) after treatment with intravitreal dexamethasone (DEX-I) and ranibizumab (IVR).

Methods

Thirty-three eyes (33 patients) with treatment naïve DME with SND were retrospectively evaluated at baseline and 2 months after DEX-I (15 eyes) and 1 month after 3 monthly IVR injections (18 eyes). Inclusion criteria were: complete eye examination, good quality OCT and OCT-A images. OCT parameters included: central macular thickness (CMT); number of hyper-reflective retinal spots (HRS) in inner, outer (IR, OR) and full retina; choroidal thickness (CT), extent of disorganization of inner retinal layers (DRIL), outer retina integrity (OR). On OCT-A: foveal avascular zone (FAZ) parameters in the superficial capillary plexus (SCP); cysts area and perfusion density (PD) in SCP and deep capillary plexus (DCP) and flow voids (FV) in choriocapillaris. FAZ was analyzed using ImageJ, perfusion parameters and FV using MATLAB.

Results

BCVA increased equally after both treatments (13.0 ± 10.0 ETDRS letters, p < 0.0001). There was a similar decrease (p < 0.05) in: height of SND, cysts area at SCP, central and mean CT, increase in FAZ perimeter and OR integrity, after both treatments. A greater decrease in DEX-I versus IVR group was found in: CMT (− 38.7% vs. − 22.2%, p = 0.012), HRS number in IR (− 29.2% vs. − 14.0%, p = 0.05) and full retina (− 24.7% vs. − 8.0%, p = 0.03), DRIL extension (− 62.0% vs. − 24%, p = 0.008), cysts area at DCP (− 68.7% vs. − 26.1%, p = 0.03), FAZ-CI (− 19.1% vs. − 8.3%, p = 0.02), PD at DCP (− 27.5%  vs. + 4.9%, p = 0.02). FV did not change.

Conclusions

More pronounced changes in specific inflammatory parameters in the inner retina are documented after steroid versus anti-VEGF treatment. These include reduction in HRS number, DRIL extension, CMT, cysts area at DCP. These data may help in further study of noninvasive imaging biomarkers for better evaluation of treatment response.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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All the authors contributed to the conception or design of the work, the acquisition, analysis and interpretation of data, drafting the work, revising it critically for important intellectual content and gave final approval of the version to be published.

Corresponding author

Correspondence to Stela Vujosevic.

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Author Stela Vujosevic has received speaker honorarium from Allergan, Bayer, Novartis, Novonordisk and has participated at advisory board of Novartis. Other authors have no conflict of interest in publishing the present work.

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The study adhered to the tenets of the Declaration of Helsinki and was approved by the institutional Ethics Committee (CE 123-2017).

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Vujosevic, S., Toma, C., Villani, E. et al. Diabetic macular edema with neuroretinal detachment: OCT and OCT-angiography biomarkers of treatment response to anti-VEGF and steroids. Acta Diabetol 57, 287–296 (2020). https://doi.org/10.1007/s00592-019-01424-4

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Keywords

  • Diabetic macular edema
  • Subfoveal neuroretinal detachment
  • OCT
  • OCT angiography
  • Inflammatory biomarkers
  • Hyper-reflective retinal spots
  • Inner retina