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Predictive factors of functional and anatomical response to dexamethasone implant in refractory diabetic macular
Y Oueslati1, H Khemiri1, S Bouchoucha1
1Department of Ophthalmology, Principal Military Hospital of Instruction, Faculty of Medicine of Tunis, Tunis, Tunisia.
Background:
To identify clinical and spectral-domain optical coherence tomography (SD-OCT) biomarkers predictive of functional and anatomical response to intravitreal dexamethasone implant in refractory diabetic macular edema (DME).
Methods:
This prospective longitudinal study included 185 eyes of 98 diabetic patients with center-involving DME refractory to a mean of 7.1±2.8 prior aflibercept (2mg) injections. All eyes received a 0.7mg intravitreal dexamethasone implant and were followed for at least 6 months, with a mean follow-up of 12.9±2.1 months. Functional outcome was assessed by best-corrected visual acuity (BCVA, logMAR) and anatomical outcome by central macular thickness (CMT) on SD-OCT. Baseline OCT biomarkers included CMT, serous retinal detachment (SRD) height, integrity of the ellipsoid zone and external limiting membrane (ELM), and disorganization of retinal inner layers (DRIL).
Results:
Baseline BCVA was 0.72±0.31 logMAR, and CMT 432±128μm. At 6 months, BCVA improved to 0.55±0.28 logMAR, and CMT decreased to 301±96μm (both P<0.001). Functional and anatomical responses were observed in 56% and 70% of eyes, respectively. Lower baseline CMT (OR=1.42, P=0.003), smaller SRD height (OR=0.76, P=0.005), fewer prior injections (OR=1.31, P=0.010), preserved ellipsoid zone (OR=2.18, P=0.002), and intact ELM (OR=1.94, P=0.004) were independently associated with favorable functional outcomes.
Conclusion:
Baseline SD-OCT biomarkers are significant predictors of treatment response in refractory DME and may support individualized therapeutic decision-making.
