Early Retinal and Choroidal Coat Thickness Changes after Intravitreal Dexamethasone Implant Injection for Diabetic Macular Edema

Abstract

Background: Intravitreal steroid injection is one of the treatment options for diabetic macular edema. Dexamethasone implant is the most novel form of intravitreal steroid therapy. Improvement in macular thickness is a well-known effect of Dexamethasone implant however, subfoveal choroidal coat thickness changes require investigation. Aims: To evaluate the early central macular thickness and subfoveal choroidal thickness alterations after single-dose dexamethasone implant injection in diabetic macular edema. Study Design: Cross-sectional study.Methods: We identified 29 patients with diabetic macular edema (29 eyes) who underwent optical coherence tomography and fundus fluorescein angiography. All patients received a single-dose intravitreal Dexamethasone implant and were followed up for central macular thickness and subfoveal choroidal thickness alterations for 1 hour, 1 week, 1 month, and 3 months post-injection. Results: The preoperative mean central macular thickness and subfoveal choroidal thickness measurements were 592.3±122.3 (412–879) μm and 264.8±53.7 (165–397) μm, respectively. Central macular thickness measurements decreased significantly in the first hour (p<0.050) and continued to decrease until the third month (p<0.001), whereas the subfoveal choroidal thickness decrement was only significant on the first day (p<0.05). Decreases in subfoveal choroidal thickness and central macular thickness of 1.5% and 5% were observed at 1 hour; however, the difference was not significant (p>0.050). The decrease in central macular thickness was significantly greater than that in subfoveal choroidal thickness at 1 day, 1 week, 1 month, and 3 months (p<0.001). Conclusion: Intravitreal Dexamethasone implant has a meaningful effect on central macular thickness in patients with diabetic macular edema, while subfoveal choroidal thickness decreases significantly at first day.

Keywords

• Choroidal coat, Dexamethasone, diabetes mellitus, macular edema

Kaynakça

1. 1. Moss SE, Klein R, Klein BE. The 14-year incidence of visual loss in a diabetic population. Ophthalmology 1998;105:998-1003.
2. 2. No authors listed. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 1985;103:1796-806.
3. 3. Chun DW, Heier JS, Topping TM, Duker JS, Bankert JM. A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema. Ophthalmology 2006;113:1706-12.
4. 4. Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, et al. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology 2013;120:1843-51.
5. 5. Yanyali A, Horozoglu F, Celik E, Nohutcu AF. Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Retina 2007;27:557-66.
6. 6. Bressler SB, Qin H, Beck RW, Chalam KV, Kim JE, Melia M, Wells JA 3rd; Diabetic Retinopathy Clinical Research Network. Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol 2012;130:1153-61.
7. 7. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, et al. Threeyear, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014;121:1904-14.
8. 8. Campochiaro PA, Brown DM, Pearson A, Chen S, Boyer D, Ruiz-Moreno J, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema. Ophthalmology 2012;119:2125-32.

9. 9. Kook D, Wolf A, Kreutzer T, Neubauer A, Strauss R, Ulbig M, et al. Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema. Retina 2008;28:1053-60.
10. 10. Roohipoor R, Sharifian E, Ghassemi F, Riazi-Esfahani M, Karkhaneh R, Fard Ma, et al. Choroidal thickness changes in proliferatıve diabetic retinopathy treated with panretinal photocoagulation versus panretinal photocoagulation with intravitreal bevacizumab. Retina 2016;36:1997-2005.
11. 11. Kim M, Cho YJ, Lee CH, Lee SC. Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections. Eye (Lond) 2016;30:718-25.
12. 12. McLeod DS, Lutty GA. High-resolution histologic analysis of the human choroidal vasculature. Invest Ophthalmol Vis Sci 1994;35:3799-811.
13. 13. Lutty GA. Effects of diabetes on the eye. Invest Ophthalmol Vis Sci 2013;54:81-7.
14. 14. Melancia D, Vicente A, Cunha JP, Abegão Pinto L, Ferreira J. Diabetic choroidopathy: a review of the current literature. Graefes Arch Clin Exp Ophthalmol 2016;254:1453- 61.
15. 15. Cao J, McLeod S, Merges CA, Lutty GA. Choriocapillaris degeneration and related pathologic changes in human diabetic eyes. Arch Ophthalmol 1998;116:589-97.
16. 16. Nagaoka T, Kitaya N, Sugawara R, Yokota H, Mori F, Hikichi T, et al. Alteration of choroidal circulation in the foveal region in patients with type 2 diabetes. Br J Ophthalmol 2004;88:1060-3.
17. 17. Spaide RF. Enhanced depth imaging optical coherence tomography of retinal pigment epithelial detachment in age related macular degeneration. Am J Ophthalmol 2009;147:644-52.
18. 18. Cheng H, Kaszubski PA, Hao H, Saade C, Cunningham C, Freund KB, et al. The Relationship between Reticular Macular Disease and Choroidal Thickness. Curr Eye Res 2016;41:1492-7.
19. 19. Chung YR, Kim JW, Kim SW, Lee K. Choroidal thickness in patients with central serous chorioretinopathy: assessment of Haller and Sattler layers. Retina 2016;36:1652-7.
20. 20. Rayess N, Rahimy E, Ying GS, Bagheri N, Ho AC, Regillo CD, et al. Baseline choroidal thickness as a predictor for response to anti-vascular endothelial growth factor therapy in diabetic macular edema. Am J Ophthalmol 2015;159:85-91.
21. 21. Regatieri CV, Branchini L, Carmody J, Fujimoto JG, Duker JS. Choroidal thickness in patients with diabetic retinopathy analyzed by spectral-domain optical coherence tomography. Retina 2012;32:563-8.
22. 22. Kim JT, Lee DH, Joe SG, Kim JG, Yoon YH. Changes in choroidal thickness in relation to the severity of retinopathy and macular edema in type 2 diabetic patients. Invest Ophthalmol Vis Sci 2013;54:3378-84.
23. 23. Ozdogan Erkul S, Kapran Z, Uyar OM. Quantitative analysis of subfoveal choroidal thickness using enhanced depth imaging optical coherence tomography in normal eyes. Int Ophthalmol 2014;34:35-40.
24. 24. Okamoto M, Matsuura T, Ogata N. Effects of panretinal photocoagulation on choroidal thickness and choroidal blood flow in patients with severe nonproliferative diabetic retinopathy. Retina 2016;36:805-11.
25. 25. Sonoda S, Sakamoto T, Yamashita T, Otsuka H, Shirasawa M, Kakiuchi N, et al. Effect of intravitreal triamcinolone acetonide or bevacizumab on choroidal thickness in eyes with diabetic macular edema. Invest Ophthalmol Vis Sci 2014;55:3979-85.
26. 26. Haller JA, Kuppermann BD, Blumenkranz MS, Williams GA, Weinberg DV, Chou C, et al. Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol 2010;128:289-96.
27. 27. Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, et al. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology 2013;120:1843-51.
28. 28. Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J, et al. A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology 2014;121:2473-81.
29. 29. Boyer DS, Faber D, Gupta S, Tabandeh H, Li XY, Liu CC, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina 2011;31:915-23