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Dril influences short-term visual outcome after intravitreal corticosteroid injection for refractory diabetic macular edema

2021-09Journal article Restricted access
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dc.contributor.authorLuís, Maria Elisa
dc.contributor.authorSampaio, Filipa
dc.contributor.authorCosta, José
dc.contributor.authorCabral, Diogo
dc.contributor.authorTeixeira, Carla
dc.contributor.authorFerreira, Joana Tavares
dc.date.accessioned2021-02-12T17:21:16Z
dc.date.available2021-02-12T17:21:16Z
dc.date.issued2021-09
dc.description.abstractPurpose: Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) are considered the gold standard for diabetic macular edema (DME). Despite adequate anti-VEGF treatments, many patients present persistent DME. The aim of this study is to identify systemic, ocular and anatomical characteristics influencing functional and anatomical outcomes in refractory DME patients treated with IVI of corticosteroid. Materials and Methods: Retrospective multicenter hospital-based cohort study including type 2 diabetic adult patients with refractory DME that switched from intravitreal anti-VEGF to intravitreal corticosteroid between January 2017 and September 2018. Sociodemographic, clinical data, DME and treatment characteristics were collected at baseline (visit before switch), as well as spectral domain OCT features. Results: A total of 101 eyes were included. The median number of anti-VEGF injections before switch was 5.0 (min-max: 4.0-9.0) and the median anti-VEGF treatment duration before switch was 33.2 (min-max: 19.5-50.3) months. More than half of the patients (56; 54.9%) were diagnosed with diffuse DME. At baseline, 80 (88%) patients had cystoid DME, 55 (62.5%) patients had disorganization of retinal inner layers (DRIL) and 16 (17.6%) had subretinal fluid. Dexamethasone was the corticosteroid more commonly used (71.4%), followed by triamcinolone (24.4%) and fluocinolone (4.2%). Regarding best corrected visual acuity (BCVA), post-switch results showed no statistically significant improvement at three-month follow-up (p = .048/0.096), but the mean central macular thickness (CMT) decreased significantly from 486.3 (SD = 159) µm to 369.3 (SD = 129) µm at three-month follow-up (p < .001). DRIL was the tomographic characteristic able to influence significantly both CMT and BCVA final results (p = .02 and 0.012, respectively). Conclusions: Subfoveal DRIL on structural OCT was the DME factor influencing significantly clinical and imaging outcomes in refractory DME patients treated with intravitreal corticosteroid. Portuguese care trend towards DME shows preference for the use of dexamethasone implant after therapeutic failure with ranibizumab or bevacizumab injection.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationLuís ME, Sampaio F, Costa J, Cabral D, Teixeira C, Ferreira JT. Dril influences short-term visual outcome after intravitreal corticosteroid injection for refractory diabetic macular edema. Curr Eye Res. 2021;46(9):1378-1386.pt_PT
dc.identifier.doi10.1080/02713683.2021.1878540pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.21/12837
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherTaylor & Francispt_PT
dc.relation.publisherversionhttps://www.tandfonline.com/doi/abs/10.1080/02713683.2021.1878540?journalCode=icey20pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectOphthalmologypt_PT
dc.subjectDiabetic macular edemapt_PT
dc.subjectRefractorypt_PT
dc.subjectIntravitreal corticosteroidpt_PT
dc.subjectDrilpt_PT
dc.subjectAnti-VEGFpt_PT
dc.subjectOptical coherence tomographypt_PT
dc.subjectVisual outcomept_PT
dc.titleDril influences short-term visual outcome after intravitreal corticosteroid injection for refractory diabetic macular edemapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage9pt_PT
oaire.citation.endPage1386pt_PT
oaire.citation.issue9pt_PT
oaire.citation.startPage1pt_PT
oaire.citation.startPage1378pt_PT
oaire.citation.titleCurrent Eye Researchpt_PT
oaire.citation.volume46pt_PT
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT

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