One-year follow-up of ischemic index changes after intravitreal dexamethasone implant for diabetic macular edema: an ultra-widefield fluorescein angiography study

Abstract

Aim

To investigate late changes in peripheral ischemia in patients affected by diabetic macular edema (DME) and treated with repeated dexamethasone (DEX) intravitreal implants over a 1-year period.

Methods

In this retrospective cohort study, patients older than 18 years of age and with type 2 non-proliferative treatment-naïve diabetic retinopathy (DR) and DME at baseline were included. All patients were treated with two intravitreal DEX implants within 1 year of follow-up. A minimum of two annual ultra-widefield fluorescein angiography (UWF FA) were required to ensure that all cases had a baseline UWF FA (< 2 weeks before first treatment with dexamethasone) and a UWF FA performed at 12 months of follow-up. On baseline and 1-year UWFA images, peripheral retinal ischemia was quantified using the ischemic index (ISI).

Results

Six eyes of five patients (two males, three females) met the inclusion criteria and were enrolled in this study. Best-corrected visual acuity was 0.34 ± 0.22 LogMAR at baseline and improved to 0.21 ± 0.14 logMAR at the 1-year follow-up visit (P = 0.050). Mean ± SD central macular thickness was 467.6 ± 63.0 μm at baseline and 272.0 ± 14.7 μm at the 1-year follow-up visit (P = 0.043). Mean ± SD ISI was 26.7 ± 14.1% at baseline and reduced to 12.2 ± 5.0% at the 1-year follow-up visit (P = 0.012).

Conclusions

Improvement in retinal perfusion is still maintained 1 year after starting treatment with DEX implants. This improvement in retinal perfusion might be related to DEX implant-related positive effects on leukostasis.

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Funding

The research for this paper was in part financially supported by Italian Ministry of Health and Fondazione Roma. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Giuseppe Querques.

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The authors have no conflict of interest to disclose.

Disclosures

Giuseppe Querques has the following disclosures: ALLERGAN (S), ALIMERA (S), AMGEN (S), BAYER (S), KHB (S), NOVARTIS (S), ROCHE (S), SANDOZ (S), ZEISS (C,S); ALLERGAN (C), ALIMERA (C), BAUSCH AND LOMB (C), BAYER (C), HEIDELBERG (C), NOVARTIS (C), ZEISS (C). Francesco Bandello has the following disclosures: ALLERGAN (S), ALIMERA (S), BAYER (S), FARMILA-THEA (S), SCHERING PHARMA (S), SANOFI-AVENTIS (S), NOVAGALI (S), PHARMA (S), HOFFMANN-LA ROCHE (S), GENETECH (S), NOVARTIS (S). Mariacristina Parravano has the following disclosures: Allergan (S), Bayer (S); Novartis (S).

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Informed consent was obtained from all patients for being included in the study.

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This article belongs to the topical collection Eye Complications of Diabetes managed by Giuseppe Querques.

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Borrelli, E., Parravano, M., Querques, L. et al. One-year follow-up of ischemic index changes after intravitreal dexamethasone implant for diabetic macular edema: an ultra-widefield fluorescein angiography study. Acta Diabetol 57, 543–548 (2020). https://doi.org/10.1007/s00592-019-01435-1

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Keywords

  • Diabetic retinopathy
  • Diabetic macular edema
  • Ultra-widefield fluorescein angiography
  • Ischemic index
  • Intravitreal dexamethasone implant