Optical Coherence Tomography Biomarkers of Inflammation in Diabetic Macular Edema Treated by Fluocinolone Acetonide Intr
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ORIGINAL RESEARCH
Optical Coherence Tomography Biomarkers of Inflammation in Diabetic Macular Edema Treated by Fluocinolone Acetonide Intravitreal Drug-Delivery System Implant Alessandro Arrigo
. Luigi Capone . Rosangela Lattanzio .
Emanuela Aragona . Piero Zollet . Francesco Bandello
Received: August 4, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: The fluocinolone acetonide (FAc) intravitreal drug-delivery system implant is a recent, second-line, intravitreal drug for the management of diabetic macular edema (DME). FAc acts against DME with a major anti-inflammatory effect. Despite the already proved efficacy, a number of patients still show persistent DME and require anti-VEGF retreatment. The main aim of the present study was to assess the relationship between quantitative biomarkers of inflammation and both DME recovery and the need for additional anti-VEGF in eyes treated by FAc implant. Methods: The study was designed as prospective and interventional with 1 year of follow-up. We analyzed structural optical coherence tomography (OCT) quantitative biomarkers of inflammation, namely choroidal hyperreflective foci (HF) and the choroidal vascularity index (CVI), and we assessed the relationship with other clinically relevant biomarkers and the outcome achieved after 1 year. Moreover, Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12860672 A. Arrigo (&) L. Capone R. Lattanzio E. Aragona P. Zollet F. Bandello Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy e-mail: [email protected]
we stratified DME eyes in good and poor responders to FAc implant to highlight clinically relevant differences. Results: Our study included 50 eyes (50 patients) treated by FAc implant. We found significant best-corrected visual acuity (BCVA) and central macular thickness (CMT) improvements after 1 year. Good responders started with worse visual acuity and higher CMT than poor responders, but gained letters significantly at the end of the follow-up, whereas poor responders showed stable BCVA values. Good responders were characterized by significantly higher choroidal HF and lower CVI than poor responders. Poor responders required significantly higher additional anti-VEGF treatments. Conclusions: Quantitative structural OCT biomarkers of inflammation allowed distinguishing different inflammatory profiles of DME. The inflammatory component helped to categorize DME eyes in good and poor responders to FAc implant. Keywords: Choroidal biomarkers; Choroidal vascularity index; Diabetic macular edema; Fluocinolone acetonide implant; Hyperreflective foci; Inflammation
Ophthalmol Ther
Key Summary Points Diabetic macular edema pathogenesis has inflammation and vasculopathy as key factors. The different contribution of these two elements may justify the heterogeneous response to anti-VEGF and intravitreal steroid treatments. Fluocinolone acetonide (FAc) intravitreal drug-delivery system implant is a r
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