Sarakshi Netralaya, Nagpur, India.
MDS Bio-Analytics Pvt. Ltd, Nagpur, India.
Eur J Ophthalmol. 2021 May;31(3):1185-1191. doi: 10.1177/1120672120925788. Epub 2020 May 20.
The purpose of this study was to determine the effects of dexamethasone implant (0.7 mg) on biomarkers such as hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases with diabetic macular edema and its effects on edema and visual acuity.
This is a prospective study of treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder patients with diabetic macular edema, treated with single dexamethasone implant. Pre- and post-injection-based best-corrected visual acuity, central macular thickness, hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers were assessed.
A total of 27 diabetic macular edema eyes, including 9 non-responder eyes, 9 eyes which received less than three anti-vascular endothelial growth factor injections and 9 treatment-naïve eyes, were included in this study. Baseline hyper-reflective dots were 22.22 ± 11.76, 30 ± 7.91 and 19.44 ± 8.82 which reduced to 3.33 ± 1.32, 9 ± 8.35 and 8.78 ± 2.53 four months after implant in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. Baseline central macular thickness was 589.44 ± 175.37, 537 ± 181.81 and 673.11 ± 138.24 and the central macular thickness after dexamethasone implant was 272.11 ± 39.00, 336.44 ± 132.88 and 524.00 ± 200.39 in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. External limiting membrane integrity was restored in two patients in each group, whereas two patients with disorganization of retinal inner layers in treatment-naïve group showed reorganization of retinal structures after treatment with dexamethasone implant.
Better response to dexamethasone implant in cases with more hyper-reflective dots shows that these hyper-reflective dots can be used as a predictive biomarker. Dexamethasone implant might help in restoring external limiting membrane integrity and resolution of disorganization of retinal inner layers.
本研究旨在确定地塞米松植入物（0.7mg）对未经治疗的患者、接受少于三次抗血管内皮生长因子注射的患者和糖尿病性黄斑水肿无反应的患者的生物标志物（如高反射点、外界膜完整性和视网膜内层的紊乱）的影响，以及其对水肿和视力的影响。
这是一项前瞻性研究，纳入了接受单次地塞米松植入物治疗的未经治疗的患者、接受少于三次抗血管内皮生长因子注射的患者和糖尿病性黄斑水肿无反应的患者。评估注射前和注射后的最佳矫正视力、中心黄斑厚度、高反射点、外界膜完整性和视网膜内层的紊乱。
本研究共纳入 27 只糖尿病性黄斑水肿眼，包括 9 只无反应眼、9 只接受少于三次抗血管内皮生长因子注射的眼和 9 只未经治疗的眼。基线时高反射点分别为 22.22±11.76、30±7.91 和 19.44±8.82，植入物植入四个月后分别降至 3.33±1.32、9±8.35 和 8.78±2.53。基线时中央黄斑厚度分别为 589.44±175.37、537±181.81 和 673.11±138.24，地塞米松植入物植入后分别为 272.11±39.00、336.44±132.88 和 524.00±200.39。在每个组中，外界膜完整性均在 2 例患者中得到恢复，而在未经治疗的组中，2 例视网膜内层紊乱的患者在接受地塞米松植入物治疗后显示出视网膜结构的重组。
更多高反射点的病例对地塞米松植入物的反应更好，表明这些高反射点可用作预测生物标志物。地塞米松植入物可能有助于恢复外界膜完整性和解决视网膜内层的紊乱。
