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. 2022 Jun 9:9:852022.
doi: 10.3389/fmed.2022.852022. eCollection 2022.

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

Yu-Te Huang  1 , Yen-Chieh Chang  1 , Ping-Ping Meng  1 , Chun-Ju Lin  1   2   3 , Chun-Ting Lai  1 , Ning-Yi Hsia  1 , Huan-Sheng Chen  4 , 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

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

Yu-Te Huang et al. Front Med (Lausanne). .

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.

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Conflict of interest statement

H-SC was employed by NephroCare Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The 25 6-mm radial scans across the retina centered on the fovea in SD-OCT.
FIGURE 2
FIGURE 2
(A) Final CRT significantly improved after treatment. (B) Mean CRT improved significantly after the third month and continuously improved up to the end of the study (month 12) (*p < 0.05 compared to before-treatment data).
FIGURE 3
FIGURE 3
(A) Final BCVA (LogMAR) significantly improved after treatment. (B) Mean BCVA improved gradually after the third month, reaching statistical significance in month 12 (*p < 0.05 compared to before-treatment data).
FIGURE 4
FIGURE 4
Serial IOP change during treatment, revealing no obvious elevation.
FIGURE 5
FIGURE 5
Model using OCT biomarkers as predictors of CRT improvement greater than 100 μm after treatment (multivariate logistic regression): the presence of SRF at baseline favored an outcome with CRT improvement > 100 μm [SRF (+) vs. (-): odds ratio 6.16 (1.75–21.6)].
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