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

Vujosevic, Stela; Toma, Caterina; Villani, Edoardo; Muraca, Andrea; Torti, Emanuele; Florimbi, Giordana; Leporati, Francesco; Brambilla, Marco; Nucci, Paolo; Cillà, Stefano De

doi:10.1007/s00592-019-01424-4

Cited by 85 publications

(94 citation statements)

References 38 publications

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“… 29 These HRS have peculiar features, such as dimension <3 0 μm, reflectivity similar to that of the nerve fiber layer, absence of back-shadowing, and location in both the inner and outer retina. 29 Previous studies have demonstrated a decrease in the number of HRS after treatment with both intravitreal dexamethasone and anti-VEGF drugs 23 , 30 , 31 ; however, no evidence has been reported so far regarding the effect of SMPL on HRS during long-term follow-up. In this study, a progressive decrease in the number of HRS was documented up to 1 year after treatment with SMPL.…”

Section: Discussionmentioning

confidence: 99%

“…In recent studies, a positive effect on DRIL extension was documented after intravitreal Dexamethasone implant, which was probably due to the reduction in retinal inflammation. 23,37 This antiinflammatory effect was hypothesized through both suppression of microglial reactivity, with a consequent protective effect on retinal neurons, and improvement in Müller cells' architecture. 23,37 In the present study, no changes were detected in retinal and choroidal perfusion parameters after compensating for possible artifacts and using different methods of analysis.…”

Section: Discussionmentioning

confidence: 99%

“…23,37 This antiinflammatory effect was hypothesized through both suppression of microglial reactivity, with a consequent protective effect on retinal neurons, and improvement in Müller cells' architecture. 23,37 In the present study, no changes were detected in retinal and choroidal perfusion parameters after compensating for possible artifacts and using different methods of analysis. This may further strengthen the hypothesis of a predominant action of SMPL on the inflammatory component of DME.…”

Section: Discussionmentioning

confidence: 99%

“… 38 There are limited data in the literature on the use of OCTA in the evaluation of DME treatment. 23 , 39 Lee et al were the first to evaluate separately the SCP and DCP in DME after treatment with anti-VEGF reporting a greater extent of microvascular damage in the DCP (reduced perfusion and a higher number of MAs) in eyes with poor response to treatment. 40 In addition, later studies confirmed the usefulness of OCTA in the assessment of DME, despite the risk of misinterpretation of data due to artifacts determined by the presence of intraretinal fluid.…”

Section: Discussionmentioning

confidence: 99%

“…1A). 23 An additional analysis of PCD was performed applying a recently published method using the full macula slab. 24 This further analysis aimed at strengthening data on retinal perfusion as less influenced by the presence of artifacts.…”

Section: Octa Parametersmentioning

confidence: 99%

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Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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The aim of this study was to evaluate 1-year quantitative changes in specific inflammatory parameters on optical coherence tomography (OCT) / optical coherence tomography angiography (OCTA) in diabetic macular edema (DME) treated with subthreshold micropulse laser (SMPL). Methods: Thirty-seven patients / eyes with previously treatment-naïve DME treated with SMPL were prospectively evaluated at 3, 6, and 12 months. Fifteen fellow eyes with only microaneurysms (MAS) not eligible for treatment were controls. Evaluated OCT / OCTA parameters included: central macular thickness (CMT); hyper-reflective retinal spots (HRS); disorganization of inner retinal layers (DRILs); MA in the superficial / deep capillary plexuses (SCP/DCP); cysts in the area at the SCP / DCP; and macular perfusion parameters (MATLAB, version 2017b). Results: In the treated group, mean best corrected visual acuity (BCVA) progressively increased from 69.4 ± 12.0 to 76.0 ± 9.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (P < 0.001) at 12 months; HRS decreased from baseline (80.75 ± 20.41) at 3 (73.81 ± 17.1, P = 0.002), 6 (69.16 ± 16.48, P < 0.0001), and 12 months (66.29 ± 18.53, P < 0.0001). MA decreased at 3 months in the DCP (P = 0.015), at 6 and 12 months in both plexuses (P ≤ 0.0007). BCVA, HRS, and MA remained stable in the controls during all follow-ups. DRIL was present in 18 of 37 patients at baseline and progressively decreased from 557.0 ± 238.7 to 387.1 ± 282.1 μm (P = 0.01). The area of cyst decreased both in the SCP (P = 0.03) and the DCP (P = 0.02). CMT and perfusion parameters did not change. Conclusions: SMPL reduced the number of HRS (sign of activated microglia cells in the retina), MA, DRIL extension, and the area of cysts. Further studies are needed to confirm these preliminary data on the anti-inflammatory effect of SMPL, and to explore the mechanism of action. Translational Relevance: The follow-up of OCT/OCTA noninvasive biomarkers offers a unique insight in the mechanism of laser action, suggesting an anti-inflammatory effect of SMPL.

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