Persistent diabetic macular edema: Definition, incidence, biomarkers, and treatment methods

Sorour, Osama; Levine, Emily S.; Baumal, Caroline R.; Elnahry, Ayman G.; Braun, Phillip X.; Girgis, Jessica; Waheed, Nadia K.

doi:10.1016/j.survophthal.2022.11.008

Cited by 32 publications

(29 citation statements)

References 199 publications

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“…Our results agree with other studies [ 4 , 30 , 31 ] in which a better morphological response to intravitreal anti-VEGF and steroids was associated with the presence of HRF. In addition, a greater HRF reduction after DEXi compared with anti-VEGF treatment has been documented [ 28 , 32 , 33 ], confirming the HRF as a biomarker of inflammatory DME pattern [ 4 , 5 , 34 ].…”

Section: Discussionmentioning

confidence: 80%

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

Costanzo

Giannini

Geronimo

et al. 2023

JCM

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Background: The aim was to evaluate predictive value of baseline optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in diabetic macular edema (DME) treated with dexamethasone implant (DEXi). Methods: OCT and OCTA parameters were collected: central macular thickness (CMT), vitreomacular abnormalities (VMIAs), intraretinal and subretinal fluid (mixed DME pattern), hyper-reflective foci (HRF), microaneurysms (MAs) reflectivity, ellipsoid zone disruption, suspended scattering particles in motion (SSPiM), perfusion density (PD), vessel length density, and foveal avascular zone. Responders’ (RES) and non-responders’ (n-RES) eyes were classified considering morphological (CMT reduction ≥ 10%) and functional (BCVA change ≥ 5 ETDRS letters) changes after DEXi. Binary logistic regression OCT, OCTA, and OCT/OCTA-based models were developed. Results: Thirty-four DME eyes were enrolled (18 treatment-naïve). OCT-based model combining DME mixed pattern + MAs + HRF and OCTA-based model combining SSPiM and PD showed the best performance to correctly classify the morphological RES eyes. In the treatment-naïve eyes, VMIAs were included with a perfect fit for n-RES eyes. Conclusion: The presence of DME mixed pattern, a high number of parafoveal HRF, hyper-reflective MAs, SSPiM in the outer nuclear layers, and high PD represent baseline predictive biomarkers for DEXi treatment responsiveness. The application of these models to treatment-naïve patients allowed a good identification of n-RES eyes.

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Section: Discussionmentioning

confidence: 80%

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

Costanzo

Giannini

Geronimo

et al. 2023

JCM

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“…A recent Diabetic Retinopathy Clinical Research (DRCR) study reported no significant differences in 2-year visual outcome for DME between aflibercept monotherapy and bevacizumab replaced with aflibercept, suggesting a rescue effect of later applied IVA [ 25 ]. However, in cases that do not respond to IVA, alternative methods such as steroids, laser treatment, or even surgery may be needed to treat the DME [ 15 , 26 ]. Of the four refractory cases presented in our study, two were treated with focal laser photocoagulation, while the others received intravitreal corticosteroid injections.…”

Section: Discussionmentioning

confidence: 99%

“…DME is not only a chronic disease but it also occurs in both eyes in most cases; therefore, it is essential to find an effective and economical treatment regimen. There are many variations in initial treatment schedules, including 3 to 6 monthly consecutive anti-VEGF injections [ 15 ]. Furthermore, many strategies were studied to maintain and maximize the effect of anti-VEGF treatment after the loading period.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus on the efficacy of loading doses and the cost-effectiveness of repeat injections due to the lack of studies that directly compare the effects of aflibercept injections after loading. A recent review revealed that the criteria on loading frequency varied by study, ranging from three to six consecutive monthly injections [ 15 ]. The national health insurance system in South Korea allowed only three consecutive injections of anti-VEGF agents for DME patients until the year 2019.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Application of Intravitreal Aflibercept Injection for Diabetic Macular Edema Comparing Two Loading Regimens

Chung

Lee

2023

Medicina

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Background and Objectives: We investigated and compared the efficacy of three and five monthly loading regimens of an intravitreal aflibercept injection (IVA) in patients with diabetic macular edema (DME). Materials and Methods: This was a retrospective study that included patients diagnosed with DME and treated with an either three or five monthly aflibercept loading regimen from July 2018 to March 2022. Information on clinical characteristics and changes in the central retinal thickness (CRT) were obtained from medical records. Results: In total, 44 eyes of 44 patients with DME treated with IVA were included in this study, with 30 eyes treated with 3-monthly loadings (three-loading group) and 14 eyes with 5-monthly loadings (five-loading group). The mean CRT significantly decreased from the baseline one month after loading in both the three-loading and five-loading groups (p < 0.001). Four cases were refractory to treatment in the three-loading group, while there were no cases of refractory DME in the five-loading group. The stability rate was significantly higher in the five-loading group at three months after loading (p = 0.033). Conclusions: Five-monthly loading regimens of IVA might be favorable for DME considering the rate of refractory cases, stable duration, and the importance of early responsiveness to IVA in DME.

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“…(2)(3)(4) Up to 50% cases do not respond well and are labeled as anti-VEGF poor responders/ persistent DME. ( 5),(6) No consensus is available at present and poor responders are de ned as less than 10-15% decrease from baseline central subfoveal thickness(CSFT) after a minimum of three to six monthly intravitreal anti-VEGF injections (7). Early control of DME is a predictive factor for vision at the end of two years and hence identifying this subset of poor responders earlier can salvage vision.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of bioclinical markers to predict short term response to intravitreal anti-VEGF in treatment-naive diabetic macular edema and the “Fried Egg” sign : a novel OCT feature

Govindaraj

Pradeep

Thulasiraman

et al. 2023

Preprint

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Objective: To determine the incidence of suspended scattering particles in motion (SSPiM) and to assess baseline bioclinical markers in treatment-naive diabetic macular edema (DME) which can predict the short term response to intravitreal anti-VEGF. Design: Prospective observational study. Participants: Treatment-naive DME patients from January 2022 to June 2022 were included in the study. Methods: Treatment-naive DME cases were included and followed up for three months. Best corrected visual acuity (BCVA), SSPiM, HbA1c levels, hyperreflective dots (HRD), sub retinal fluid (SRF), central subfoveal thickness (CSFT), optical density ratio (ODR) of the largest cyst near the fovea, type of cyst (uniformly hyperreflective or fragmented intracystic hyperreflectivity called "fried egg" sign) at baseline were studied to predict response to treatment after anti-VEGF. Results: 123 eyes of 88 patients were included in the study. Incidence of SSPiM was 64.5%.The mean incidence of poor responders was 35%. BCVA, ODR, hyperreflective cysts and presence of SSPiM were not associated with response to anti-VEGF. Higher CSFT, SRF, higher number of HRD, presence of SSPiM in the outer nuclear layer (ONL) and outer plexiform layer (OPL) were associated with short term good response to anti-VEGF. High HbA1c and presence of "fried egg" sign in the hyperreflective cysts were associated with poor response. Conclusion: Higher CSFT, SSPiM in the ONL and OPL, and higher HRD were associated with good response to antI-VEGF. High HbA1c and "fried egg" sign was associated with poor response to anti-VEGF. BCVA, presence of SSPiM and ODR were not associated with anti-VEGF response.

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Persistent diabetic macular edema: Definition, incidence, biomarkers, and treatment methods

Cited by 32 publications

References 199 publications

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

Clinical Application of Intravitreal Aflibercept Injection for Diabetic Macular Edema Comparing Two Loading Regimens

Evaluation of bioclinical markers to predict short term response to intravitreal anti-VEGF in treatment-naive diabetic macular edema and the “Fried Egg” sign : a novel OCT feature

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