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Changes in hyperreflective foci in refractory diabetic macular edema after switch to dexamethasone implant
D El Ghazi1, A Bechara Ghobril1, A Miere1
1Department of Ophthalmology, University Paris-Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France.
Purpose:
To evaluate changes in hyperreflective foci (HRF) in refractory diabetic macular edema (DME) after switching from intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy to intravitreal dexamethasone implant (DEX-I).
Methods:
A retrospective study was conducted, including 30 eyes of 22 patients with DME who were switched from intravitreal injection of anti-VEGF to DEX-I. HRF count, central macular thickness (CMT) and best-corrected visual acuity (BCVA) were recorded at baseline (M0), i.e., before the switch to DEX-I, as well as at 2 months (M2) and 6 months (M6) of follow-up. Two independent readers assessed the quantitative variables.
Results:
The mean age was 72.76±12.93 (11 males, 11 females), and the number of HRF decreased significantly from M0 to M6, with a mean number of HRF at M0 of 44.82±23.58 and 36.51±15.18 at M6 (P=0.0281) after the switch to DEX-I. There was a significant reduction in CMT from M0 to M6, from 450.76±116.82 at M0 and 339.53±134.32 at M6 (P=0.00061). BCVA significantly improved by 10 ETDRS letters from M0 to M6.
Conclusion:
HRF decreased significantly after the switch from anti-VEGF therapy to DEX-I in eyes with refractory DME, and this reduction was accompanied by improvements in both CMT and BCVA at month 6. These results suggest that HRF may represent a sensitive and dynamic biomarker of treatment response in this patient population.
