Abstract
Purpose
To assess the clinical significance of suspended scattering particles in motion (SSPiM) and different cystic phenotypes in diabetic macular oedema (DME) treated with dexamethasone implant (DEX-i).
Methods
A retrospective review of type 2 diabetic patients with DME treated with a DEX-i was conducted. Swept-source optical coherence tomography angiography (OCTA, PLEX Elite 9000) with a 3-mm volume cube was performed. Regions of interest were delineated with Fiji software (version 2.1.0/1.53.c) in the superficial vascular complex (SVC) and deep capillary plexus (DCP) at baseline, 2- and 4-months after DEX-i. SSPiM was defined as regions of variable reflectivity with a decorrelation signal. Without a detectable decorrelation signal, its counterpart was addressed as ‘corpuscular,’ while hyporeflective cysts were optical empty without hyperreflective material enclosed.
Results
After treatment, the hyporeflective component demonstrated substantial reabsorption in the SVC (–95.4% at 2- and –84.4% at 4-months, p < 0.01 both) and DVC (–84.4%, 2-months), with a less critical decrease of the corpuscular component in the SVC (2-months: –41.9%, p = 0.001 and 4 months: –1.8%, p = 0.73), and not significant in the DVC. SSPiM did not significantly change in the SVC and DVC neither at 2- and 4-months (p > 0.05, all).
Conclusions
After a single DEX-i, the clearance of different cystic phenotypes proceeds with resorption of hyporeflective, followed by corpuscular components. SSPiM demonstrated minimal response, indicating a severe BRB breakdown that may require repeated treatment to reach a satisfactory anatomical response.
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Acknowledgements
The research for this paper was financially supported by the Italian Ministry of Health and Fondazione Roma. The authors gratefully acknowledge Puma Foundation for its support. The funders had no role in study design, data collection, analysis, decision to publish, or paper preparation.
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MP and SF were responsible for designing and writing the study; EC, DDG and PV conducted the retrospective search, verified the eligibility, and extracting data; DG and SR analysed the data and interpreted the results; GQ reviewed critically and provided writing support of the final draft.
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The authors have no competing interests regarding the publication of this study. MP reports personal fees from Allergan, Novartis, Bayer, Zeiss, Omikron, Alfaintes, Sifi outside the submitted work. PV, EC, DG, SF, DDG has nothing to disclose. SR reported personal fees from: Novartis, Bayer, Zeiss outside the submitted work. GQ: Alimera Sciences, Inc.: Consultant/Advisor; Allegro: Advisor; Allergan: Consultant/Advisor; Apellis: Consultant/Advisor; Baush & Lomb: Consultant; Bayer Healthcare Pharmaceuticals: Consultant/Advisor; Boehringer Ingelheim: Advisor; CenterVue: Consultant/Advisor; Heidelberg Engineering: Consultant/Advisor; Lumithera: Advisor; Nevacar: Advisor; Novartis Pharmaceuticals Corporation: Consultant/Advisor; Roche: Consultant/Advisor. SIFI: Advisor/Consultant; Sooft/Fidia: Consultant; Topcon: Consultant; Thea: Consultant; Zeiss: Consultant/Advisor.
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Parravano, M., Fragiotta, S., Costanzo, E. et al. Differences in cysts characteristics and related influence on the anatomical response after dexamethasone implant in diabetic macular oedema. Eye 36, 1329–1331 (2022). https://doi.org/10.1038/s41433-021-01857-8
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DOI: https://doi.org/10.1038/s41433-021-01857-8
