1
|
Munk MR, Somfai GM, de Smet MD, Donati G, Menke MN, Garweg JG, Ceklic L. The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers. Int J Mol Sci 2022; 23:ijms23147585. [PMID: 35886930 PMCID: PMC9319632 DOI: 10.3390/ijms23147585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.
Collapse
Affiliation(s)
- Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
- Correspondence: ; Tel.: +41-31-632-25-01
| | - Gabor Mark Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland;
- Spross Research Institute, 8063 Zurich, Switzerland
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Marc D. de Smet
- Medical/Surgical Retina and Ocular Inflammation, University of Lausanne, MIOS SA, 1015 Lausanne, Switzerland;
| | - Guy Donati
- Centre Ophtalmologique de la Colline, University of Geneve, 1205 Geneve, Switzerland;
| | - Marcel N. Menke
- Department of Ophthalmology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Justus G. Garweg
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, 3012 Bern, Switzerland;
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| |
Collapse
|
2
|
Podkowinski D, Beka S, Mursch-Edlmayr AS, Strauss RW, Fischer L, Bolz M. A Swept source optical coherence tomography angiography study: Imaging artifacts and comparison of non-perfusion areas with fluorescein angiography in diabetic macular edema. PLoS One 2021; 16:e0249918. [PMID: 33831123 PMCID: PMC8031733 DOI: 10.1371/journal.pone.0249918] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/26/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Swept Source Optical coherence tomography angiography (SS-OCTA) is a novel technique to visualize perfusion and vascular changes like ischemia in patients with diabetic retinopathy. The aim of this study was to compare non-perfusion areas on conventional fluorescein angiography (FA) with those on SS-OCTA using detailed manual annotation in patients with diabetic macular edema (DME) and to evaluate possible artifacts caused by DME on SS-OCTA. Methods 27 eyes of 21 patients with DME were analyzed in this prospective, cross-sectional study; on all, standard ophthalmological examination, SS-OCTA and FA imaging were performed. Early-phase FA and SS-OCTA images were analyzed for capillary dropout and foveal avascular zone (FAZ) was measured on both modalities. Artifacts in SS-OCTA imaging caused by DME were marked and analyzed. Results The mean age of the patients was 62.6 ± 11.5 years. On FA the mean size of the annotated non-perfusion areas was 0.14 ± 0.31 mm2 whereas the mean size in SS-OCTA was 0.04 ± 0.13 mm2; areas marked on FA were statistically significantly larger than on SS-OCTA (p<0.01). Mean size of FAZs was similar between FA and OCTA images. (p = 0.91). Seven eyes (25.9 percent) showed imaging artifacts due to DME in SS-OCTA. Conclusion SS-OCTA is a valid tool to analyze capillary perfusion status of patients with DME, although areas of non-perfusion were measured smaller than in conventional FA. More non-perfusion areas were found on SS-OCTA images. FAZ measurements were similar using the two modalities. However, SS-OCTA is prone to artifacts and therefore requires reviewing of imaging results: up to 25 percent of the analyzed eyes showed artifacts on OCTA, which occurred in the areas of diabetic macular edema and did not correspond to capillary drop out.
Collapse
Affiliation(s)
- Dominika Podkowinski
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
- Johannes Kepler University, Linz, Austria
| | - Sophie Beka
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
- Johannes Kepler University, Linz, Austria
| | - Anna-Sophie Mursch-Edlmayr
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
- Johannes Kepler University, Linz, Austria
| | - Rupert W. Strauss
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
- Medical University Graz, Graz, Austria
| | - Lukas Fischer
- Software Competence Center Hagenberg GmbH (SCCH), Hagenberg, Austria
| | - Matthias Bolz
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
- Johannes Kepler University, Linz, Austria
- * E-mail:
| |
Collapse
|
3
|
Mahdjoubi A, Bousnina Y, Bendib FS, Bensmaine F, Idlefqih W, Chahed S, Ghezzaz A. Large-cube 30° × 25° optical coherence tomography in diabetic macular edema. Int J Retina Vitreous 2021; 7:19. [PMID: 33676574 PMCID: PMC7937234 DOI: 10.1186/s40942-021-00289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/19/2021] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the contribution of large-cube 30° × 25° optical coherence tomography (OCT) in the characterization of diabetic macular edema (DME) by assessing its extent and the presence of additional retinal edemas and to evaluate the factors that influenced their occurrence. Methods This retrospective study enrolled patients with diabetes who presented with retinal edema detected by horizontal large-cube 30° × 25° (8.7 × 7.3 mm) OCT. Two individualized areas were selected from the thickness map: the area within the 6-mm Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, and that outside the ETDRS grid. Retinal edemas located within the ETDRS grid were designated as “main DME” and those located outside the ETDRS grid were designated as “peripheral retinal edemas.” For each area, OCT features were assessed while the extent of the main DME and the presence of peripheral retinal oedema were analysed in the area outside the ETDRS grid. Finally, part of included eyes was followed by the same protocol, of which a part benefited from intravitreal injections. Results Peripheral events were detected outside the ETDRS area in 279 eyes (74.4%) of the 375 eyes of the 218 patients included in this study: an extension of the main DME outside ETDRS grid in 177 eyes (47.2%) and/or the presence of peripheral retinal edemas in 207 eyes (55.2%). The analysis of associations between main DME and peripheral retinal edemas patterns did not find an association for retinal cyst localization (P = 0.42) while a week association was found fort cyst size (Cramer’s V = 0.188, p = 0.028). Nevertheless, a moderate association was found for the presence of microaneurysms (Cramer’s V = 0.247, p < 0.001) and strong association for hard exudates (Cramer’s V = 0.386, p < 0.001), The binary logistic regression analysis retained the following influencing factors of the occurrence of peripheral events: advanced DR stage (Odds ratio OR = 2.19, p = 0.03), diffuse DME (OR = 7.76, p < 0.001) and its location in outer fields (OR = 7.09, p = 0.006). Likewise, the extension of the main DME outside the ETDRS area in was influenced by the same factors in addition to CMT (OR = 0.98, p = 0.004) while the presence of peripheral retinal edema was influenced by the same factors except the outer location of the Main DME. Finally, from the 94 eyes treated by intravitreal injections, extension of the main DME outside the ETDRS grid was detected in 54 eyes (56.44%) at baseline visit and still remained detectable in 37 eyes (39.36%) after treatment initiation. Conclusions Large-cube 30° × 25° OCT allowed for more precise assessment of DME extension and better detection of retinal thickening mainly in the advanced stages of diabetic retinopathy with significant DME whether at the baseline visit or during follow-up. The combination of this protocol with a wider ETDRS grid would enhance DME detection and topography.
Collapse
Affiliation(s)
- Amir Mahdjoubi
- Department of Ophthalmology, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France. .,Department of Ophthalmology, Hôpital Simone Veil, Eaubonne, France.
| | - Youcef Bousnina
- Department of Ophthalmology, Hôpital Max Forestier, Nanterre, France
| | - Fatma-Samia Bendib
- Department of Endocrinology and Diabetology, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Faiza Bensmaine
- Department of Endocrinology and Diabetology, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Wafa Idlefqih
- Department of Ophthalmology, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France
| | - Sadri Chahed
- Department of Ophthalmology, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France.,Department of Ophthalmology, Hôpital Simone Veil, Eaubonne, France
| | - Amina Ghezzaz
- Department of Ophthalmology, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France.,Department of Ophthalmology, Hôpital Simone Veil, Eaubonne, France
| |
Collapse
|
4
|
Bolz M, Podkowinski D, Pretzl J, Mursch‐Edlmayr A, Luft N, Ring M. Patterns of morphologic alteration correlate with vision in diabetic macular oedema: a cross-sectional evaluation of patients using the SAVE II protocol. Acta Ophthalmol 2020; 98:e400-e406. [PMID: 31736255 DOI: 10.1111/aos.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to describe and evaluate patients with clinically significant diabetic macular oedema (CSME) according to the improved SAVE II protocol and correlate findings with visual acuity and systemic parameters in the outpatient clinic for DR (diabetic retinopathy) management. METHODS This was a cross-sectional case series study of patients with CSME, regardless of prior treatment. Visual acuity testing was performed according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol. Optical coherence tomography (OCT) and fluorescence angiography (FA) were performed. All imaging data were evaluated according to an improved version of the SAVE grading protocol for CSME (SAVE II). The main outcome measures were SAVE II oedema types and best-corrected visual acuity. Additional parameters of a blood sample (fasting glucose, haemoglobin A1c, serum creatinine, triglycerides, cholesterol, low-density lipoproteins, and high-density lipoproteins) were taken. RESULTS In total, 66 eyes of 66 patients were included. The mean age of the patients was 64.9 ± 8.2 years. Two eyes were classified as SAVE oedema type 1, 19 eyes as SAVE oedema type 2, 28 eyes as SAVE oedema type 3, and 28 eyes as SAVE oedema type 4, respectively. Central retinal thickness and laboratory parameters were not significantly different between the groups. There was a statistically significant difference in ETDRS visual acuity between the SAVE groups 2 and 4 (p < 0.001) with lower vision in group 4. There was no statistically significant difference between oedema types 2 and 3 (p = 0.065) and oedema types 3 and 4 (p = 0.13). CONCLUSION There was a significant correlation between the four defined oedema types and visual acuity. Morphologic findings did not correlate with any of the evaluated blood parameters.
Collapse
Affiliation(s)
- Matthias Bolz
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Dominika Podkowinski
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Josef Pretzl
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
| | - Anna‐Sophie Mursch‐Edlmayr
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Nikolaus Luft
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
| | - Michael Ring
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Center for Medical Research Johannes Kepler University Linz Austria
| | | |
Collapse
|
5
|
Panozzo G, Cicinelli MV, Augustin AJ, Battaglia Parodi M, Cunha-Vaz J, Guarnaccia G, Kodjikian L, Jampol LM, Jünemann A, Lanzetta P, Löwenstein A, Midena E, Navarro R, Querques G, Ricci F, Schmidt-Erfurth U, Silva RMD, Sivaprasad S, Varano M, Virgili G, Bandello F. An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification. Eur J Ophthalmol 2019; 30:8-18. [PMID: 31718271 DOI: 10.1177/1120672119880394] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. METHODS The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. RESULTS Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. CONCLUSION A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.
Collapse
Affiliation(s)
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Albert J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Josè Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), University of Coimbra, Coimbra, Portugal
| | | | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, CHU de LYON, Hospices Civils de Lyon & Université de Lyon 1, Lyon, France
| | - Lee Merrill Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anselm Jünemann
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Paolo Lanzetta
- Istituto Europeo di Microchirurgia Oculare (IEMO), University of Udine, Udine, Italy
| | - Anat Löwenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Ricci
- UOSD Patologie Retiniche, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Ursula Schmidt-Erfurth
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rufino Martins da Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Monica Varano
- IRCCS Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia, Rome, Italy
| | - Gianni Virgili
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
6
|
Morphologische retinale Charakteristika von Patienten mit einer Sehbehinderung infolge eines diabetischen Makulaödems. Ophthalmologe 2018; 116:563-568. [DOI: 10.1007/s00347-018-0759-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
7
|
Feng XX, Li C, Shao WW, Yuan YG, Qian XB, Zheng QS, Li YJ, Gao QY. Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report. Int J Ophthalmol 2018; 11:429-437. [PMID: 29600177 DOI: 10.18240/ijo.2018.03.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/05/2018] [Indexed: 01/02/2023] Open
Abstract
AIM To evaluate the efficacy and safety of combined anti-vascular endothelial growth factor (VEGF) agents, oral glucocorticoid, and laser photocoagulation therapy for macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal vessel oxygenation were examined over 12mo. RESULTS Patients received 1.43±0.81 anti-VEGF injections. Mean baseline and 12-month logMAR BCVA were 0.96±0.51 (20/178) and 0.31±0.88 (20/40), respectively, in eyes with central retinal vein occlusion (CRVO) (P<0.00), and 1.02±0.45 (20/209) and 0.60±0.49 (20/80), respectively, in eyes with branch retinal vein occlusion (BRVO) (P<0.00). At 12mo, CRT had significantly decreased in eyes with CRVO (P<0.00) and BRVO (P<0.00). Venous oxygen saturation had significantly increased in eyes with CRVO (P<0.00) and BRVO (P<0.00). No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. CONCLUSION Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO-associated ME.
Collapse
Affiliation(s)
- Xiao-Xiao Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Cheng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Wan-Wen Shao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yong-Guang Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Bing Qian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Qi-Shan Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yu-Jie Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Qian-Ying Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| |
Collapse
|